434 (1) HORNSEY BOROUGH OF HORNSEY. ANNUAL REPORTS FOR 1927 OF THE Medical Officer of Health AND School Medical Officer. W. WILSON JAMESON, M. A.M.D., M.R.C.P., D.P.H., Barristtr-at-Law. Borough of Sornsep. ANNUAL REPORT FOR 1927 of the Medical Officer of Health. INDEX. Acts in force, 43. Admissions to Hospital, 39. Ambulances, 12. Area of Borough, 4. Attack rate, infectious disease, 40. Bacteriological examinations. 20. "Better Health" journal. 33. Births and rates, 4, 8, 35, 88. Borough Nursing Association, 9, 81. By laws in force, 43. Cancer deaths, 38. Carbide licences, 15. Cerebro-spinal meningitis, 39, 40. Cinemas. 13, 16. Cleansing Station, 26. Committees, 1. Complaints, 15. Deaths and rates. 4 8, 18, 85, 38. ,, Causes of. 8, 36. Demolition of houses. 21 Dental treatment, 30. Diarrhœa, 25, 38. Diphtheria. 23, 24, 38, 39, 40. Diseases of Animals, 22, 32. Disinfection. 14, 26. Dysentery, 25, 40. Encephalitis Lethargica. 25, 40. Enteric fever. 25, 88, 39, 40. Erysipelas, 39, 40. Factories and Workshops. 13, 16, 45 Families. 1921, Number of. 4. Food inspection, 22 , 23. Hornsey Central Hospital 10. Hornsey Deanery Association. 9. Hornsey Nursing Association. 9, 81. Hospital, admissions to, 39. Housing.— House-to-house inspections. 13, 21. Demolitions, 21. Families re-housed. 19. Return of year's work. 47. Schemes, 20. Statistics of two areas. 17. Illegitimate Births. 8. Infant deaths and rates, 4, 8, 28, 35. 37, 38. .„Causes. 37. Infantile paralysis. 25, 89, 40. diarrhœa, 25, 38. Infectious Disease.— Diphtheria. 23, 24 , 38, 39, 40. immunization. 24. return cases. 24. Notifications. 39, 40. Infectious Disease.— Scarlet Fever, 28, 38, 39 , 40. ,, return cases, £4. Verminous persons, 13, 26. Visits as to, 13. Influenza, 25. Vaccine, 25. Inhabited houses. 4. Inquests, 12. Inspections made. 13, 15. Isolation Hospital, 11, 27. New buildings, plan and cost. 27. ,, Cases admitted to, 39. Lying-in homes, 10. Malaria, 39, 40. Maternity cases arrangements. 11, 29. Maternity and Child Welfare Committee. 1. Maternity and Child Welfare.— Analysis of attendances. 29, 42. Cases admitted to Hospital. 11, 29 Dental treatment. 30. Fathers' Committee, 30. Massage. 30. Maternal deaths. 28. Midwife's work. 29, 42. Milk grants. 30. Sessions. 10, 29. Voluntary Committee work. 30. Year's work. 28, 29, 42. Measles, 38, 40. Meat inspection. 22. Midwives. 10, 29, 42. Milk grants. 30. Milk licences, 22. „ samples. 22. Mortuary. 12. North London Nursing Association. 9. North Middlesex Hospital, 10. 18. Notices served. 13. Nursing Association, 9, 31. Do. Grant to. 9, 31. Do. History of, 31. Nursing Homes, 10. Ophthalmia Neonatorum. 25, 39 , 40. Out-relief, 9, 18. Outworkers. 46. Para-typhoid. 39, 40. Petroleum stores and licences, 13, 15. Pneumonia, 8, 25,39, 40. Regulations, 25. Poisons Act licences. 15. Poliomyelitis. 25, 39, 40. Poor-law relief, 9, 18. Population. 4, 7, 35, 38. Preface. 3. Public Health Committee. 1. Puerperal Fever and Pyrexia. 28, 39, 40 Rag Flock Act, 15. Rateable value and produce of 1d. rate. 4. Regulations in force, 43. Return cases, 24. Rent and Mortgage Interest Restriction Act. 13, 15. Sale of Food and Drugs Act, 23. Sanitary Work. 13. Scarlet Fever, 23, 38, 39 , 40. Schick testing, 24. School Clinics 11. Shops Acts, 15. Slaughter houses. 13, 22. Small pox, 11, 40. Smoke nuisances, 13. Statutory notices, 13. Swine fever. 22 , 32. Stuff. Health Department, 2. Still births, 8. Tables, List of, 34. Tuberculosis Cases of, 13, 25, 39, 41. Sanatoria and beds. 12. 24, 25. ,, Dispensary, 11. deaths and rates. 4, 8, 25. 38, 41. Typhoid fever, 25, 38, 39, 40. Vaccine, 25. Verminous persons. 13, 26. Venereal disease clinics, 11. Veterinary Inspector's report. 32. Vital Statistics. 4, 35. Voluntary Committees. 30. Water supply, 4. Whooping cough. 38 Zymotic deAth rate. 4 1 PUBLIC HEALTH COMMITTEE, 1927. Councillor E. Brooks (Chairman). The Mayor, Alderman W. G. Barrenger, J.P. The Deputy-Mayor, Councillor R. Steeds, J.P. Alderman H. B. Brackenbury. ,, J. A. Dunmore. ,, H. E. Hill. Councillor Mrs. C. M. Cave. ,, J. Edwards. ,, P. Everington. ,, S. G. Goolding. „ W. E. Lee. ,, J. W. Rowlands. ,, J. W. Shipp. ,, A. Storey. ,, L. J. Valette. ,, R. H. L. Watson. MATERNITY AND CHILD WELFARE COMMITTEE, 1927. Councillor S. G. Goulding (Chairman). The Mayor, Alderman W. G. Barrenger, J.P. The Deputy-Mayor, Councillor R. Steeds, J.P. Alderman H. B. Brackenbury. Councillor Mrs. C. M. Cave. ,, P. Everington. ,, H. E. Hill. W. E. Lee. ,, L. J. Valette. ,, R. H. L. Watson. ,, R. Ff. Wootton. Co-opted Members. Mrs. J. H. Barrenger. Mrs. J. L. Bond. Mrs. M. N. Hill. Mrs. A. L. M. Harvey. Miss A. M. Inward. Mrs. E. Piggott, Mrs. B. H. Walton. — 2 — STAFF OF PUBLIC HEALTH DEPARTMENT, *†Medical Officer of Health ‡Deputy Medical Officer of Health and Resident Medical Officer, Joint Isolation Hospital *†Assistant Medical Officer for Maternity and Child Welfare purposes * † Senior Sanitary Inspector *†Sanitary Inspectors †Chief Clerk † Assistant Clerks *†Health Visitors *†Midwife † Mortuary Keeper †Disinfectors †Motor-Ambulance Driver ‡ Veterinary Inspector under Diseases of Animals Acts W. W. Jameson, M.A., M D , M.R.C.P., D.P.H. J. R. Prior, M.D., LL.13., D.P.H. Jessie Muir, M.B Wm. Thorpe. Henry Eastwood. James Goodman. Joseph H. Jesse. John D. Chance. Wm. Gilroy. E. Cheesman. R. C. Matthews. David Mellows. A. Glover. J. I. Macpherson. E. Durnford. F. R. H. Ross. M. Andrews. C. F. Catlin. W. H. Lewis. J. Saywood. E. Palmer. F. G. Buxton, M.R.C.V S Ncte:—† Whole time Officers. ‡ Part time Officers. * Officers in respect of whom salary contribution is made under the Public Health Acts or by Exchequer Grants. — 3 — To the Mayor, Aldermen and Councillors of the Borough of Hornsey. Mrs. Cave and Gentlemen, I have the honour to present to you my Annual Report on the health of the Borough of Hornsey for the year 1927. The most noteworthy feature of the year's vital statistics is the decline in the infantile mortality rate. The figure—38.3 per 1,000 births—is the lowest ever recorded in the history of the Borough. Other matters of interest which have occurred during the year are the opening of the extensions to the Joint Isolation Hospital, the formation of a District Nursing Association, and the appointment of Dr. Jessie Muir as the Council's first whole-time Medical Officer for maternity and child welfare purposes. I have added a few notes on Hornsey's water supply, and I have to acknowledge my indebtedness to one of Sir Alexander Houston's fascinating reports for much of the information I have given. My thanks are again due to the Chairmen of the Public Health Committee and of the Maternity and Child Welfare Committee for their consideration and help, and to Dr. Prior, Dr. Muir, Mr. Thorpe and Mr. Gilroy for their ungrudging assistance at all times. I have the honour to be, Mrs. Cave and Gentlemen, Your obedient servant, WILSON JAMESON, Medical Officer of Health. — 4 — STATISTICS AND SOCIAL CONDITIONS FOR 1927. Area 2,874 acres. Population (census 1921) 87,691 Estimated population (middle of 1927) 90,000 Number of inhabited houses (census 1921) 17,333 Number of private families (census 1921) 23,353 Rateable value £745,054 Product of a penny rate £3,100 Births- Male 589 Female 612 Total 1,201 Birth-rate, 13.3 per 1,000 population. Deaths— Male 455 Female 557 Total 1,012 Death-rate, 11.2 per 1,000 population. Death-rate of infants under one year of age per 1,000 births 38.3 Death-rate from tuberculosis (all forms) per 1,000 living 0.7 Death-rate from zymotic disease per 1,000 living 0.13 THE WATER WE DRINK. To town dwellers a pure and abundant supply of water is such a commonplace that it is only when the supply is cut off, as happened in so many houses last year during the severe frost, that the importance of such a service is demonstrated. During the early part of last century the inhabitants of what is now the Borough of Hornsey obtained their water supplies mainly from wells. One of these wells at any rate was famous. Muswell Hill derives its name from an old well, the site of which was apparently in Muswell Road, almost opposite Coniston Road. This part of Muswell Hill, east of Colney Hatch Lane and extending from near the Broadway, Muswell Hill, to Goodwyn's Vale, belonged to the fraternity of St. John of Jerusalem, whose headquarters were in Clerkenwell. A chapel — 5 — was built here probably about 1120, in which was placed the image of "Our Lady of Muswell," and to this shrine pilgrims came from all parts of the country. Some miraculous cures were said to have been effected by the water of this well. The water from wells in Southwood Lane was at one time celebrated for the purpose of bathing " weak eyes." Persons came from great distances to fetch it, and it was sold in London as " Highgate eye water." The last wells in Southwood Lane were closed in 1873. In 1819 a formal complaint was made at the " Court Leet that drainage was finding its way into the ponds on the top of Highgate Hill (the site now known as South Grove), which had been for two hundred years the only source of water supply for the poor and for those who did not possess wells of their own. It is said that " a nameless hermit dwelling in the Hermitage, where now the school is, on his own cost caused ground to be digged on the top of Highgate Hill, where is now a fair pool of water, and therewith made a causeway from Highgate to Islington; a two-handed charity, providing water on the hill, where it was wanted, and cleanliness in the vale, which before, especially in the winter, was passed with much tribulation." In Highgate water used to be carted up the hill on occasions and sold at prices varying from twopence to one halfpenny per bucket, according to the degree of competition. The last vendor of water died as recently as 1064, the year in which New, River water was supplied to Highgate and the old ponds on the top of the hill filled in and planted over by public subscription. The last public well in Hornsey was situated in Crouch End. It was more than 160 feet deep and the water, which was very highly esteemed, was soft and very unlike that drawn from most of the surface wells in the neighbourhood. It always yielded an abundant and pure supply. Most of the surface wells had their water drained off when railway cuttings were made throughout the district and when sewers were laid down, but the Crouch End well was still in use in 1875. By this date the New River water had been supplied to most of the houses in the area. In his twentieth Annual Report to the Metropolitan Water Board, Sir Alexander Houston, Director of Water Examination, has written in a most charming manner of " the romance of the — 6 — New River." In bringing the pure waters of the Chadwell and Amwell springs to London over 300 years ago, Sir Hugh Myddelton performed an act of almost unparalleled importance. Indomitable fighter as he was, he could never have succeeded without the moral support of the Corporation of London and the never-to-be-forgotten financial aid of King James I., who guaranteed half the expenses and was entitled to half the profits. There were thirty-six adventurers who shared the other half of the profits or losses, each adventurer having practically a l/72nd stake in the undertaking. The original adventurers had no issued shares, they simply stood to gain or lose on a proportionate l/72nd basis. The so-called shares were in reality undivided parts of a freehold estate, descending to the heir-in-law in case of death or intestacy and conveyed in the same manner as landed property. It has been computed that about 1611 the capital value of each adventurer's share was £336, with, as it turned out, a waiting period of twenty years before receipts exceeded expenditure. In time, increasing dividends were paid (£2,924 a share in 1900), and the value of the shares materially increased with the dividend, the record price being for part of a share sold in 1896 at the rate of £128,500 for the entire share. The Arbitration Court awarded the New River Company the sum of £5,967,123 for their undertaking. The New River, which is now twenty-seven miles long, commenced originally at Chadwell Springs (named after St. Chad) above Ware. Practically the New River may now be said to start from the intake on the upper River Lea at King's Mead, Hertford. A little below the junction of the upper Lea and the Chadwell channels is the first of fourteen wells, the water of which is pumped into the New River along its course. These wells and Chadwell Springs raise the volume of New River water from a minimum of 22.5 million gallons, taken from the Lpper Lea at King's Mead, to an average of about 35 million gallons per day at Homsey, although the maximum yield must be at least 55 million gallons. Sir Alexander Houston gives a delightful description of the passage of the New River through Hertfordshire and Middlesex, and illustrates his narrative with numbers of beautiful photographs. — 7 — In Hornsey the course of the New River has lost most of its former beauty, [???] years ago the river flowed " from the direction of Wood Green parallel with Nightingale Lane, crossed Priory Road opposite the end of the lane and, inclining to the east, immediately crossed the end of Middle Lane, proceeding through the gardens of the ' Three Compasses,' then returning, re-crossed the main road first below the Rectory gardens, and describing an arc once again crossed the road below the church near the present railway bridge. The wandering stream, flanked by some fine old trees, gave great life and beauty to the village, which, crowned as it was by the ivy-covered tower of the old church and backed by the rising ground of Muswell Hill and Highgate Woods, was noted for its picturesque beauty, and was a very great attraction to visitors who flocked to the numerous tea gardens in the neighbourhood during the summer season." Just after emerging from the railway arch the New River flows into the apex of a small triangular basin, which feeds Hornsey storage reservoir and the continuation of the river from its eastern end. Hornsey reservoir covers about eight acres and holds 8.5 million gallons or less than a day's supply (109 million gallons) from these works. There are also eight slow sand filters, covering nearly six acres. Campsbourne Well, the last of the New River Wells, is situated at the Hornsey Works, and the water may be pumped either into the New River or into the filtered water tank. There is no more fitting description of the task accomplished by Sir Hugh Myddelton than this— " An immortal work: since men cannot more nearly imitate the Deity, than in bestowing Health." POPULATION, BIRTHS AND DEATHS. Population.—The estimated population at the middle of 1927 was 90,000. The Registrar-General's estimate M as 86,810— a decrease of 881 on the Census figure of 1921. It is highlyimprobable that the population of Hornsey has diminished in the past seven years, as a considerable number of new houses have been built, including the Council's new housing estate of 427 houses at Muswell Hill, and many houses have been divided into flats. — 8 — Births.—Twelve hundred and one babies were born in Hornsey, the birth rate being 133 per 1,000 population—a slight decrease on the figure (13'4) for the previous year. Forty-eight of the births were illegitimate. Eleven hundred and sixty-four births (including 265 transferred from other districts and 136 transferred to other districts) were notified to the Medical Officer of Health under the Notification of Births Acts. These figures include 31 stillbirths, of which 11 were transferred from other districts and 4 were transferred to other districts. One hundred and forty-eight un-notified births were extracted from the Registrar's returns. Stillbirths.—The Births and Deaths Registration Act, 1926, which came into force on the 1st July, 1927, requires the registration of stillbirths with the Registrar of Births and Deaths. Fourteen stillbirths were registered between 1st July and 30th December. The excess of births over deaths for the year was 189. Deaths.—The total number of deaths during 1927 was 1,012 —the death-rate being 11'2 per 1,000 population. The rate for 1926 was 10.6. Causes of death.—The most frequent causes of death, set out as percentages of the total deaths, were as follows : — Heart disease 19.8 per cent. Cancer 13.7 „ „ Pneumonia and bronchitis 12.8 „ „ Cerebral hæmorrhage and arterio-sclerosis 9.7 „ „ Tuberculosis 6.8 ,, Table B. on page 36 shows the number of deaths due to various causes during the past seven years. Deaths from pulmonary tuberculosis have slightly decreased in number, and deaths from pneumonia and bronchitis also show a decline. Infant mortality rate.—There were 46 deaths of infants under one year of age, including 9 of illegitimate infants, in 1927. This is equal to an infant mortality rate of 38.3 per 1,000 births— the lowest figure in the history of the Borough. The infant mortality rate of illegitimate children was 191. The infant mortality rate for England and Wales was 69. — 9 — Out-relief.—During 1927 the Guardians distributed the following sums in out-relief: — Cases. Cost. Ordinary 571 £13,334 Unemployed 441 6,818 1,012 £20,152 Eighteen more persons received relief than in 1926, and the expenditure was nearly £3,000 more. The number of ordinary cases shows an increase and the number of unemployed cases a decrease. SUMMARY OF NURSING, HOSPITAL AND OTHER INSTITUTIONS AVAILABLE IN THE DISTRICT. Nursing.—The Hornsey District Nursing Association, which had been formed at the time of issue of my last Report, commenced its activities on the 1st July, and now covers the whole of the Borough, in addition to a small part of Tottenham near Green Lanes and a small part of St. Pancras at the top of Highgate Hill. In return for a grant of 25 guineas a year commencing on the 20th September, 1927, the Association undertakes to nurse cases of measles and whooping cough, and in return for an annual grant of £5 by the Education Committee commencing on 1st January, 1928, to visit when necessary children who have been operated on for enlarged tonsils and adenoids. A full account of the Association's inauguration and work will be found on page 31. The arrangement, instituted in November, 1925, with the North London Nursing Association for the nursing of children below school age in the southern and eastern parts of the Borough, for which the Council paid a sum of 1s. 4d. a visit, was discontinued on the taking over of this area by the Borough Nursing Association. The Hornsey Deanery Association for Preventive and Rescue Work at 109, Upper Tollington Park, receives unmarried mothers and their babies. A grant of £50 was made by the Council during the year, and the Association also receives a grant — 10 — from the Ministry of Health. The Institute has accommodation for five unmarried mothers and their children, and for five expectant mothers. Babies are usually kept until four months old. The housework is done by the expectant and nursing mothers. The women are confined as a rule in Queen Charlotte's, the City of London or the Royal Free Hospital, while a few are sent to North Middlesex Hospital. The accommodation is becoming insufficient for the institute's work, and negotiations are in progress to obtain additional premises with accommodation for 12 nursing or expectant mothers and for " toddlers " as well as for babies. Hospitals.—The North Middlesex Hospital (Edmonton Union) has 950 beds for in-patients. The number of Hornsey cases admitted during the year was 874, viz., 177 maternity cases and 697 other cases. Thirty of the maternity cases were mothers attending the Council's Welfare Centres. The Hornsey Central Hospital, with 49 beds, dealt with 910 cases, of which 809 belonged to Hornsey. The Council contributed £50 last year to the Hospital. Midwives.—In addition to the Municipal Midwife, who in controlled and paid by the Council, there are 17 Midwives notified to the County Council as practising in the Borough. The County Council is the Local Supervising Authority under the Midwives Acts. Lying-in homes.—There are 19 lying-in homes registered with the County Council under the Middlesex County Council (General Powers) Act, 1921. Clinic and Treatment Centres.— Maternity and Child Welfare Centres. (No. 1.) Brook Road Hall, N.8. (opened 1916). Monday (2nd and 4th in month), 2-4. Wednesday, 10-12 and 2-4. Thursday, 10-12 and (ante-natal) 2-4. (No. 2.) 22, Wightman Road, Harringay, N.4. (opened 1918). Monday (1st and 3rd in month), ante-natal, 2-4. Tuesday, 10-12 and 2-4. (No. 3) Church Road Highgate, N.6. (opened October, 1925). Friday, 10-12 and 2-4. — 11 — School Clinics. Topsfield Parade, Crouch End, X 8. Daily. 9.5. Saturdays. 9-1. Brook Road Centre Wightman Road Centre Highgate Centre Daily, 9-10 a.m. Tuberculosis Dispensary (Middlesex County Council).— 10, Alexandra Road, Hornsey. Tuesday and Thursday, 2.30 p.m. Wednesday, 10 a.m. Venereal Disease Clinic (Middlesex County Council).— Royal Northern Hospital, Holloway Road, N.7. Men—Monday, Wednesday, Thursday and Friday, 6-8 p.m. Women—Monday, 2.30-4 p.m., Tuesday and Thursday, 6-8 p.m. Women—Monday, 2.30-4.30 p.m. Prince of Wales' Hospital, Tottenham, N. Men—Monday, 7-8 p.m., Wednesday, 6-7 p.m., Friday 6.30-8 p.m. Women.—Monday, 6-7 p.m., Wednesday, 4.30-6 p.m., Friday, 5.30-6.30 p.m. Maternity.—The arrangements made with the North Middlesex Hospital and the Royal Free Hospital for the reception of maternity cases attending the Maternity and Child Welfare Centres at charges of 6/- and 10/- a day respectively continue in operation. Thirty cases were admitted to Hospital under these arrangements during the year. Infectious Disease.—Cases of infectious disease are sent to the Isolation Hospital, Coppett's Road, Muswell Hill, N.10., which is controlled by a Joint Hospital Committee for the districts of Hornsey, Finchley and Wood Green. An account of the recent additions will be found on page 27. Small-pox.—The arrangement for the treatment of cases of small-pox in the Uxbridge Joint Small-Pox Hospital at Yeading, Middlesex, is still in force, but it is hoped that in the near future an agreement may be entered into by the Middlesex County Council for the treatment in the hospitals of the Metropolitan Asylums Board of all cases occurring within the County. — 12 — Tuberculosis.—There are 772 beds available under the Middlesex County Council scheme for the treatment of tuberculosis in sanatoria allotted as follows: — Observation. Pulmonary tuberculosis. Nonpulmonary tuberculosis. Total. "Sanatorium" Beds. " Hospital" Beds. Disease of Bones & Joints. Other conditions. Adult Males 9 152 128 28 8 325 Adult Female* 7 152 68 30 18 275 Children under 15 8 56 - 72 36 172 Total 24 360 *196 130 62 772 •66 male and 66 female beds classified as " hospital " beds are at Clare Hall Hospital and are available for hospital or sanatorium cases as necessary. Ambulances.—The Borough Ambulance is kept at the Central Fire Station under the control of the Borough Engineer and Surveyor, and during the year has been used for the conveyance of 821 persons on 804 occasions, as follows:—166 street accidents and 638 private and other cases. The Ambulance for the medical services of the Borough, which is used mainly for the conveyance of school children, has covered 13,482 miles during the year. Owing to the great increase in the work done by this Ambulance, particularly in the Muswell Hill School journeys, it was found necessary to replace the original vehicle, which had run altogether 30,482 miles in four years. A Guy chassis was accordingly purchased, and the old ambulance body fitted to it at a total cost of £460. The new motor conveyance has been running since the re-opening of the schools after the summer holidays. Mortuary.—During the year 45 bodies were brought to the mortuary at the Sanitary Depot, Hornsey, and 27 inquests were held by the Coroner. SANITARY WORK. The following survey of work done by the Sanitary Inspectors has been supplied to me by Mr. Thorpe, the Senior Sanitary Inspector: — — 13 — Inspections. House-to-house inspections 372 Increase of Rents Acts inspections 7 Inspections 953 Re-inspections of work in progress 8,766 Visits to Factories, Workshops and Outworkers 1,295 ,, Petroleum Stores 284 ,, Slaughter-houses 415 ,, Restaurant Kitchens 71 ,, Bakehouses 71 ,, Cowsheds, Dairies and Milk-shops 98 ,, Ice-cream premises 68 ,, Food shops 410 ,, Stables 174 ,, Urinals 90 ,, Cinemas 37 Smoke inspections and observations taken 9 Visits re Infectious Disease notified 315 ,, other Infectious Disease 19 ,, Vermin 10 ,, Tuberculosis, etc. 103 ,, Deaths 151 Notices Served. Informal Notices served (general) 912 do. do. do. (Increase of Rent Acts) 7 Statutory Notices served: — Under sec. 41, Public Health Act, 1875, to examine drains 2 Under sec. 41, Public Health Act, 1875, to relay drains 2 Under sec. 91, Public Health Act, 1875, to abate nuisances 123 In 123 instances where the Occupier was also the owner the work was carried out without a written notice. Summary of Sanitary Improvements carried out. Drainage.— Number of houses and premises re-drained 37 Repairs or amendments to existing drains 90 Drains or gullies unstopped or cleansed 68 Manholes provided 70 Manholes altered and repaired 50 Intercepting traps fixed 40 — 14 — New gully traps fixed 129 New soil-pipes and ventilating shafts fixed 43 Soil-pipes and ventilating shafts repaired 42 Water tests applied 45 Smoke tests applied 113 Drains examined, Public Health Act, 1875 (Section 41) 2 Water-closets and Sanitary Fittings.— New water-closet basins fixed 107 Water-closets unstopped, cleansed or repaired 69 New check cisterns fitted to water-closets 15 Existing check cisterns repaired 53 Water-closet apartments repaired 14 New impervious sinks provided 86 New waste-pipes fixed 39 Waste-pipes trapped, repaired or unstopped 198 Miscellaneous.— Roofs repaired 298 Eaves guttering renewed, cleansed or repaired 188 New eaves guttering provided 39 Rain-water pipes provided 52 Rain-water pipes repaired or unstopped 106 Stack pipes disconnected from drains 17 Damp walls remedied 95 Paving of yards repaired 167 Structural repairs of premises 383 Rooms cleansed, distempered or re-papered 621 Workrooms cleansed and repaired 16 Drinking-water cisterns repaired, cleansed and covered 116 Movable sanitary dustbins provided 89 Accumulations of manure and refuse removed 50 Stoves and ranges repaired 36 Coppers repaired 19 Miscellaneous 369 Infectious Disease and Disinfection.— Number of rooms fumigated after infectious disease 707 Verminous rooms fumigated 63 Number of articles disinfected 8,687 Number of articles destroyed 335 — 15 — Complaints.—Complaints were received in respect of 303 alleged nuisances. All the premises concerned were inspected and, where nuisances were found, the necessary steps were taken to have them abated. Premises periodically inspected.—The following premises were visited periodically during the year, and any matters requiring attention were dealt with: — Description of Premises. No. in District. Dairies and milkshops 32 Ice-cream premises 68 Bakehouses 30 Restaurant kitchens 35 Slaughter-houses 5 Butchers' shops 52 Fish shops 23 Food shops 269 Factories, workshops and outworkers' work-places 485 Cinemas 7 Rent and Mortgage Interest (Restriction) Acts.—Seven forma] applications for certificates under these Acts were received. In each instance the necessary repairs were carried out by the owners. Petroleum Acts, etc.— Two-gallon can stores. Bulk stores. Number of licences in force 68 40 28 Carbide of Calcium and Hydro Carbon.— Number of licences in force 6 - - Poisons and Pharmacy Act.— Number of licences in force 2 - - The premises where petrol is stored are visited regularly and a list with particulars is sent to the Superintendent of the Fire Brigade each year. Rag Flock Act.—Ten visits have been made to upholsterers' premises where rag flock is used. Shops Acts.—Regular inspections have been made in regard to the closing of shops at the hours set out in the Shops (Early Closing) Act, Generally speaking this Act is well observed, but — 16 — where an, infringement has occurred the attention of the shopkeeper has been called to the matter and an undertaking obtained that the contravention will not recur, in all cases with satisfactory results. Close attention is paid to the provisions of the Shops Act, 1912, and to the closing of shops for the weekly half-holiday. Apart from neglect to display the prescribed forms in a few instances, all of which have received attention on notice being given to the shopkeeper, the Act has generally been well observed. Six hundred and forty-three inspections were made under the Shops Acts. Cinemas.—Cinemas and places of public entertainment have been visited on 37 occasions, attention being directed to the sanitary conveniences and the general cleanliness of the premises. It is pleasing to report that in no instance have the conditions been found other than satisfactory. Factory and Workshop Acts.—The total number of Factories, Workshops and Work-places on the register is 485. The businesses carried on at the respective premises arc as follows: — Bakehouses 30 Dressmakers and milliners 80 Bootmakers and boot repairers 55 Tailors 31 Laundries 13 Motor and cycle engineers 46 Restaurant kitchens and manufacture of cooked meats 35 Upholstery 15 Builders 12 Other Trades 168 485 HOUSING. The following table continues the comparison, instituted for the first time in the report for 1926, between two small adjoining areas. One comprises the streets east of Nightingale Lane, and the other Nightingale Lane and the streets immediately to the west: — — 17 — SECTION A.-—Compsburne Road. Myddelton Road, Boy ton Road, Pembroke Road, Brook Road. Eastfiedl Road and Newlands Road. SECTION B — Nightingale Lane, North View Road, South View Road, Hawthorn Road and Beechwood Road. Houses. Total Persons. Census Population 1921. Parsons per house. 464 4189 All ages. Under 14. 14 and over. 9.07 Section A M. F. M. F. M. F. 2039 2150 721 755 1318 1395 Section B 736 3006 1447 1559 415 408 1032 1151 4.08 Note.—The majority of the houses in Section A have three floors, whereas in Section B they have two floors or are self-contained flats. Year. Birth Rates. Infant Mortality Rates. Death Fates. * Inward Transfer Deaths Percentage. T.B. Death Rate- Infectious Disease Attack Rates. Borough a b Borough A b Borough a b Borough a b Borough a B Borough a b 1921 16.7 30.0 16.3 49.0 87.0 20.4 11.0 10.8 7.3 31 61 36 1.0 1.6 2 3 10.1 26.6 22.2 1922 15.4 29.9 14.3 54.0 89.0 0 11.2 10.5 8.3 32 50 40 0.8 0.7 1.0 6.2 17.6 12.3 1923 14.4 22.9 12.3 51.0 83.3 0 10.5 8.1 6.6 33 47 45 0.6 0.7 1.0 4.2 14.1 6.9 1924 13.4 24.3 14.3 41.0 19.6 0 10.4 10.0 6.3 33 55 42 0.6 0.9 1.6 4.0 5.2 4.6 1925 13 6 25.3 13.6 43.6 38.0 24.6 10.6 8.8 7.9 34 31 54 0.5 0.7 1.0 3.3 3.4 3.3 1926 13.4 18.8 11.6 47.2 25.9 28.6 10.3 8.1 7.3 37 64 63 0.8 0.2 0.3 4.0 5.8 2.2 1927 13.3 20.0 8.3 38.3 42.5 0 11.2 9.0 7.9 36 48 46 0.7 0.9 0.7 4.4 5.7 3.3 * These are deaths of Hornsey residents occurring outside the Borough, e.g., in hospitals, nursing homes, etc. — 18 — Section. A. consists mainly of rather old houses each originally intended for occupation by one family only, but now inhabited by two, three or even four families. These houses are owned by a great many different landlords, most of whom spend a considerable amount of money on their property. There is some overcrowding, sub-letting is extremely common, and certain of the tenants are of a careless and irresponsible type. Section B. is a block of property owned and managed very largely by the Borough Council and by the Metropolitan House Investment Company. The tenants have been to a large extent selected, most families live in self-contained dwellings, and there is very little overcrowding. I am indebted to Mr. Parry, the Relieving Officer, for the following particulars of the number of families relieved during 1927, and of the number of persons removed to the North Middlesex Hospital from the various streets in the two sections: — Families receiving Poor Law relief. A Persons admitted to North Middlesex Hospital. Campsbourne Road 84 33 Myddelton Road 56 29 Boyton Road 38 20 Pembroke Road 4 11 Brook Road 37 15 Eastfield Road 4 5 Newlands Road 4 7 227 120 Section B. Nightingale Lane 4 3 North View Road 10 5 South View Road 3 7 Hawthorn Road 2 5 Beechwood Road 5 6 24 26 — 19 — Re-housing.—During the past year 119 families, representing 624 persons, have been re-housed, as follows: — From. Families. Persons. Campsbourne Road 19 106 Myddelton Road 10 52 Boyton Road 6 37 Brook Road 3 17 High Street, Hornsey 3 15 Pembroke Road 2 12 St. Mary's Road 9 50 Birkbeck Road 3 18 Westfield Road 2 9 Rectory Road 1 6 St. Anne's Circus 1 4 Holland Road 1 4 Rathcoole Gardens 8 39 Nelson Road 2 11 Montague Road 2 9 Enfield Gardens 1 8 Hanbury Road 1 5 Inderwick Road 1 4 Gordon Road 1 4 Canon Road 1 4 Spencer Road 1 4 Clarendon Road 5 26 Turnpike Lane 3 19 Lyttieton Road 3 14 Denmark Road 2 8 Park Road 2 13 The Grove 3 13 Middle Lane 1 8 Lynton Road 1 5 New Road 1 5 Archway Road 8 33 North Hill 4 19 Orchard Road 3 13 Holmesdale Road 1 9 Woodside Cottages 1 5 Woodstock Road 3 16 119 624 — 20 — The average number of persons in each of these families is 5.2. In order to prevent a recurrence of overcrowding, the Sanitary Inspectors pay special visits to all houses about to be vacated by tenants who have been allocated dwellings on one or other of the Council's Estates. BOROUGH HOUSING SCHEME. The following is a complete list of the Council's housing schemes, the dates of the first lettings being given in each case : — Hornsey, 1st Scheme. (June, 1896.) 40 Two bedroom, parlour cottages. 68 Three bedroom, parlour cottages. 108 Highgate, 1st Scheme. (December, 1900.) 24 Tenements. 24 Two bedroom, non-parlour cottages. 12 Three bedroom, parlour cottages. 60 Hornsey, 2nd Scheme. (February, 1904.) 36 Two bedroom, non-parlour cottages, with bath. 38 Two bedroom, parlour cottages, with bath. 40 Three bedroom, parlour cottages, with bath. 26 Four bedroom, parlour cottages, with bath. 140 Highgate, 2nd Scheme. (January, 1913.) 92 Three bedroom, non-parlour cottages, with bath. 36 Two bedroom, non-parlour cottages, with bath. 128 — 21 — Muswell Hill Estate. (December, 1924, to November, 1927.) 61 Four bedroom, parlour houses, with bath. 201 Three bedroom, parlour cottages, with bath. 131 Three bedroom, non-parlour cottages, with bath. 34 Two bedroom, non-parlour cottages, with bath. 427 Rectory Gardens Estate. (July, 1927.) 18 Three bedroom, non-parlour cottages, with bath. 14 Three bedroom, parlour cottages, with bath. 32 Total 895. In addition to the above there are three houses, Nos. 38, 40, 42, Myddelton Road, owned by the Council, which are let out to several families. The inclusive rents of the various dwellings range from 11/6 to 22/- per week. House-to-house inspection.—The following table gives a comparison of pre-war and post-war conditions as a result of house-to-house inspection in a number of roads: — Pre-war. Post-war. Number of houses inspected 176 176 Average number of rooms per house 41 41 Total number of families 214 236 Total number of persons over 10 years 648 703 Total number of persons under 10 years 301 204 Average number of persons per house 5.4 51 Average number of persons per room 1.8 11 Average number of persons per room used for sleeping 2.0 1.9 Number of houses with more than 2 persons per room 6 5 Number of houses with more than 2.5 persons per bedroom 35 36 Number of houses sub-let 126 40 (N.B.—A child under 10 rears is counted as 0.5 person.) Demolitions.—During the year three old wooden houses, Nos. 103, 105 and 107, North Hill, for which closing orders had been made by the Council, were vacated and pulled down. — 22 — INSPECTION AND SUPERVISION OF FOOD. Milk.—The following are the registration and licensing figures for 1927: — Premises registered as dairies 63 Licensed pasteurizing plants 2 Premises licensed for sale of " Pasteurized Milk " 18 Premises licensed to sell " Certified Milk " 11 Premises licensed to sell " Grade A (tuberculin tested) Milk " 4 Thirty samples of milk from roundsmen have been taken by the Chief Inspector and submitted to bacteriological examination. Where the results were not satisfactory the milk vendor was interviewed, and in every case methods were suggested and agreed to for the better handing of the milk. Meat.—Under the Public Health (Meat) Regulations, 1924, notice of intention to slaughter has to be sent to the Town Hall by all butchers who have slaughter-houses in Hornsey. In this way the Inspectors are enabled to inspect the carcase and organs of every animal killed in the Borough. The general standard of meat sold in Hornsey is good. During the year the carcases of 2,374 sheep, of 144 beasts, of 21 pigs and of 16 calves were inspected under the Regulations, and 997 lbs. of meat, 98 lbs. of pork and 664 lbs. of offal were surrendered voluntarily on account of some diseased condition. All diseased meat and offal are destroyed in the Corporation incinerator. Two hundred and fiftyfour lbs. of fish and 9 lbs. of walnuts were also condemned and destroyed. Swine fever.—An outbreak of swine fever was discovered by the Veterinary Inspector among a batch of 22 pigs brought into the Borough in December. All necessary steps were taken and the animals were inspected by the Inspector of the Board of Agriculture. Three of the affected pigs died. Slaughter-houses.—The following is a statement regarding the slaughter-houses in the Borough: — In Dec., 1926. In Dec., 1927. Licensed 5 5 Other foods.—Particular attention was given to all premises where food is prepared or sold. During the year 727 visits of inspection were paid to the various food premises in the Borough. 23 Sale of Food and Drugs Act.—Mr. Kobinson, Chief Officer of the Public Control Department of the Middlesex County Council, has very kindly sent me the following list of samples purchased in Hornsey during the year ended 31st December, 1927:— Article. Taken. Adulterated. Milk 186 6 Cream 4 0 Butter 1 0 Meat 18 0 Meat, cooked 1 0 Beef, minced 6 1 Brawn 3 0 Sausages 41 7 Sausages, cooked 19 0 Sausage skins 1 0 Prawns 2 0 Fish paste 12 0 Preservatives 5 2 Seasonings 2 1 Vegetables, tinned 2 0 Whisky 2 0 305 17 Prosecutions 3 Convictions 3 INFECTIOUS DISEASE. Scarlet fever and diphtheria.—Scarlet fever showed a rather higher incidence in 1927 than in 1926—the number of notifications being 179 as compared with 140, whereas there were only 92 notifications of diphtheria as compared with 116 in 1926. Seventythree per cent, of the cases of scarlet fever and eighty-eight per cent, of the cases of diphtheria were removed to hospital. The former disease caused one death and the latter six. Scarlet fever still continues to be of a mild type, and the policy of removing to hospital large numbers of the sufferers is of doubtful public health value; many cases could quite well be nursed at home and more accommodation in hospital would thus become available for severe cases of measles and of whooping cough. 24 The following table shows the incidence of infecting cases discharged from the Isolation Hospital since 1921:— YEAR. SOARLRT FEVER. Persons Infected "Return Cases" Infecting Cases. Percentage of infecting cases. DIPHTHERIA. Persons Infected " Return Cases" Infecting Cases. Percentage of infecting cases. 1921 571 14 12 2.1 189 2 1 0.53 1922 201 10 7 3.43 103 — — — 1923 100 5 5 5.0 113 — — — 1924 159 14* 7 4.4 33 — — — 1925 77 1 1 1.3 43 — — — 1926 89 4 2 2.2 101 — — — 1927 131 5 4 3.0 81 — — — * Including two cases belonging to other hospitals. Return, cases" mean cases occurring in the same house or elsewhere and apparently traceable to the person released, within a period of not less than twenty-four hours or not more than twenty-eight days after his return or release from isolation. The Medical Officer of Health visits all households where return " cases of scarlet fever or of diphtheria have occurred, and the infecting cases are carefully examined for some evidence of continuing infection. Schick testing.—A commencement has been made with the Schick testing and subsequent immunization against diphtheria of children brought to the various Maternity and Child Welfare Centres, and the numbers so dealt with will be recorded in subsequent reports. Tuberculosis.—The following statement shows the condition of the register at the beginning and at the end of the year:— No. of cases at commencement of 1927. No. of cases added to register during 1927. No. of cases removed from register during 1927. No. of cases on register at end of 1927. Pul. Non.-Pul. Pul. Non.-Pul. Pul. Non. Pul. Pul. Non.-Pul. Males 203 53 39 10 36 4 206 59 Females 184 48 47 12 37 8 194 52 25 The total number of cases on the Tuberculosis Register at the end of 1927 was 511. The cases were removed from the register for the following reasons:— Deaths 47 Removed from district 23 Cured or disease arrested 15 85 The average number of beds in residential institutions available for Middlesex patients suffering from tuberculosis during 1927 was 772, details of which will be found on page 12. The number of deaths from tuberculosis in Hornsey wa6 64 in 1927—the death-rate being 0.7 per 1,000. The rate in 1926 was 0.76. The number of notifications of pulmonary tuberculosis during the year was 86, and of other forms of tuberculosis 22. A detailed list of new cases of, and deaths from, tuberculosis will be found in Table G. (page 41). Influenza and pneumonia.—Influenza showed a somewhat increased incidence during the year, 54 deaths being attributed to this cause, as compared with 13 in 1926. The number of notifications of pneumonia was 89 and the number of deaths 69. The Ministry of Health has made new regulations dealing with the notification of pneumonia, malaria and dysentery, which came into force on the 1st January, 1928. The whole of the supply of anti-catarrhal vaccine supplied to medical practitioners at cost price by the Town Council was soon exhausted, some 4,800 c.c. having been issued. Other infectious diseases.—Seven cases of typhoid and paratyphoid fevers were notified, with 1 death. Three cases of poliomyelitis (infantile paralysis) were notified, but no case of encephalitis lethargica. There were no deaths from measles or whooping cough, but 4 children under two years died of diarrhœa during the year. No case of small-pox occurred in the Borough. Ophthalmia neonatorum.—Five cases of ophthalmia neonatorum were notified during the year. All these cases were visited by the Health Visitors, and treatment was carried out by them or the District Nurses where necessary. An arrangement exists with the Metropolitan Asylums Board for the admission 26 of cases of this disease to St. Margaret's Hospital, Kentish Town, but none of the cases mentioned required removal to hospital. Cases. Notified. Treated At home. In hospital. Vision unimpaired. Vision impaired. Total blindness Deaths. 5 5 0 5 0 6 0 Cleansing and. disinfection.—Verminous persons and persons suffering from scabies may be cleansed at the Cleansing Station, High Street, Hornsey. A well-equipped station is provided, and during 1927 nine adults and 129 school children received treatment. The clothing of such persons is disinfected at the time of cleansing, and in many cases it is found possible to disinfect the homes as well. Disinfection is offered in cases of death from tuberculosis, cancer, pneumonia and other diseases. In 117 of the 379 instances in which the service was offered it was accepted. The following is a record of the disinfection work carried out during the year:— Premises. Rooms disinfected. Articles disinfected. Articles destroyed. Notifiable diseases 326 400 6084 26 Non-notifiable diseases 376 307 2603 309 Total 702 707 8687 335 Laboratory work.—With, the exception of the more complicated blood tests all the routine bacteriological work is carried out at the laboratory of the Joint Isolation Hospital. The following district work was done during 1927:— Positive. Negative. Total. Examinations for diphtheria bacilli 111 989 1,100 ,, ,, tubercle bacilli 26 210 236 ,, ,, typhoid bacilli 4 7 11 Other examinations 11 18 29 152 1,224 1,376 27 ISOLATION HOSPITAL. The Isolation Hospital, established in 1889, has grown from an institution containing only ten beds to one with accommodation for one hundred and thirty patients. In 1922 the Hospital became the joint property of Hornsey, Finchley and Wood Green, and in July, 1927, certain important extensions were opened by Mr. G. L. T. Locker-Lampson, Under-Secretary of State for Foreign Affairs and Member of Parliament for Wood Green. These extensions include a nurses' home containing thirty-nine bedrooms and certain public rooms, a gate-porter's lodge, and an isolation block of twenty beds in cubicle wards. In addition, certain alterations were made in the existing administrative block. It will be seen from the attached plan that this isolation block is built in the shape of a cross with a central duty room, octagonal in shape, measuring 22 feet from side to side. Each cubicle is 12 feet deep, 10 feet wide and 10 feet high, and is separated by plate-glass partitions from those adjoining. In this way an uninterruped view of the interior of all the cubicles is obtained from the duty room. Each limb of the cross contains five cubicles, and at the end of each limb is a sanitary annexe. Two of these annexes are provided with discharge rooms. The detached block opposite the duty room contains a linen room, 10 feet by 9 feet 6 inches, a larder and a staff lavatory and water closet. A glazed verandah, 7 feet wide, runs in front of the entrances to all cubicles. The boiler house, which lies underneath the duty room, has three separate coke boilers, one for the ordinary hot water supply, another for the radiator circulation, and a third for the Manlove-Alliott disinfector (placed in the duty room), which is used for the disinfection of all dishes and cutler}'. The fittings and furnishings are simple. Each cubicle has its own wash-hand basin and three-fold screen on a frame work of enamelled iron. Three overalls hang inside each room. Bedpans, numbered to correspond with the number of the cubicles, are kept in racks in special sluice rooms at the end of cach limb. Separate towels, hair-brushes, tongue-depressors and such like are provided in each cubicle. All the beds are 2 feet 6 inches wide, except those in the four end cubicles, which are 8 feet wide. Doors are made sufficiently wide to allow beds to be wheeled out on to the verandah. 28 This type of isolation block requires a plot of land some 130 feet square. The cost of the block was £7,634, and of the furnishings £921—£8,555 in all. The Nurses' Home and other extensions, including the making of roads, the laying out of the grounds and furniture, cost altogether £15,273. MATERNITY AND CHILD WELFARE. Beport by Dr. Jessie Muir, Assistant Medical Officer of Health:— "The infantile mortality rate for 1927 was 38.3—the lowest ever recorded for the Borough. The figures for England and Wales, for London and for the 107 Great Towns were respectively 69, 59 and 71. Never before has the rate for Hornsey fallen below 41. Of the 46 infant deaths, details of which will be found in Table C. on page 37, no fewer than 33 were of infants under the age of four weeks, and of these neo-natal deaths, as they are called, 21 were attributable to premature birth. This has for some years been the chief cause of death among infants in Hornsey and, so far as is known at present, the only means of prevention is for the expectant mother to receive adequate medical supervision during her period of pregnancy. The lack of care in the case of illegitimate infants is shown by their appalling mortality—of 48 illegitimate infants born in Hornsey during 1927 no fewer than 9 died before reaching the age of one year. Three mothers died as a result of their confinements—one from sepsis and two from other causes. The maternal mortality rate was thus 2.49 per 1,000 births. All these deaths occurred in institutions, and none attended the ante-natal consultations. The arrangement made by the Town Council for the provision of the services of consultants in cases of puerperal fever and puerperal pyrexia has proved helpful to medical practitioners during the past year. Fourteen notifications of puerperal pyrexia were received and a consultant was called in on six occasions. In no instance was it found necessary to make special bacteriological examinations, to admit the patient to hospital or to provide a visiting nurse. 29 Midwifery.— Miss Andrews, the Municipal Midwife, attended 122 confinements during 1927—a reduction of 31 on the figure for the preceding year. This reduction was due largely to the fact that Miss Andrews was absent for considerable periods on account of illness. In addition, a good many of the poorer families, ordinarily attended by the Municipal Midwife, were allotted houses on the Coppett's Road Estate, where the services of other midwives are available. Miss Andrews attended 64 ante-natal clinics during the year, and made 1,893 visits to the homes of the mothers. Since the municipal midwife was first appointed in 1922 she has attended 560 confinements. During the year a sum of £208 15s. was received from women attended by Miss Andrews, notwithstanding that a reduction of fee was made in 43 cases. Thirty women from Hornsey were admitted to the maternity wards of the North Middlesex Hospital, at a total cost of £146 2s. Towards this sum the mothers themselves contributed £112. Centres.—The re-arrangement of the consultation hours at the three centres has made it possible for special cases to be seen at times other than during ordinary sessions. In the same way more opportunities are now afforded for discussion of certain aspects of the work with the various Health Visitors to the benefit, not only of the centre staffs, but also of those attending for advice. An endeavour has been made to reduce to reasonable proportions the number of mothers and babies coming to a centre on any one day. The best results are not achieved when, on account of excessive attendances, adequate attention cannot be given to individual cases either by the Medical Officer or by the Health Visitor. During the year 789 babies were brought to the centres for the first time, and 1,764 babies made 12,889 attendances at the centres. At the ante-natal consultations 285 expectant mothers were seen for the first time and 596 attended as 'old cases.' At Highgate Centre an attempt has been made to discover the extent to which parents, who might be expected to bring their babies to the centre, do in fact attend. Out of 544 babies entered on the register as suitable for visiting under the 30 tion of Births Acts, 441, or 81 per cent., were actually brought to the centre. Of these 441, 81 per cent, attended during the first year, 35 per cent, during the second year, 17 per cent, during the third, and 8 per cent, during the fourth. It will be noticed that a sharp drop in the attendances occurs after the age of 3 years. Recent investigations have shown that considerable defects are found to exist in children of this age; defects which in many instances lead to permanent disability if not promptly dealt with. Attempts are being made to call up for medical examination as many children at the age of 3 years as can conveniently be accommodated at the centres. I am indebted to Miss Knox, one of the Voluntary Workers at the Highgate Centre, for the careful analysis of attendances noted above. Details of the work done in connection with maternity and child welfare work will be found in Table H, page 4'2. The Voluntary Workers attached to each Centre have given me all possible assistance, and I wish to record my deep appretion, not only of their help to me personally, but also of their untiring efforts on behalf of the mothers and babies. The workers have raised considerable sums of money, which have been spent mainly on the provision of massage, convalescent home treatment and dental treatment. The actual figures are as follows:— Massage 61 Dental treatment 30 Sent to convalescent homes 43 Holidays 9 Surgical instruments 7 Spectacles 1 The Fathers' Committee at Brook Road Centre have again subscribed liberally to the voluntary funds. Supply of milk.—During the year 223 cases have received milk free or at less than cost price. The sum so expended amounted to £88 0s.lld. In another 20 instances the application for milk was not granted. Jessie Muir." 31 BOROUGH OF HORNSEY NURSING ASSOCIATION. On. the 17th December, 1926, at a public meeting called by the Mayor of Homsey, it was decided to form a Borough Nursing Association. At a subsequent meeting on the 6th January, 1927, a provisional Committee was appointed and steps were taken to organise a house-to-house canvass. Much help was received from St. Mary's Nursing Society and from various religious and other bodies in the Borough. Many enthusiastic voluntary helpers gave their services, with the result that in a short time an association was established and nursing services made available for local residents. Annual grants of 25 guineas and £5 are made to the Association by the Town Council and the Education Committee respectively. The success of the undertaking has been due in most part to the thoroughness, ability and hard work of its first Honorary Secretary, Mr. R. H. Crookall, whose methods of organization must be regarded as a model of their kind. The Association is indeed fortunate to have secured the help of a man so imbued with the spirit of public service as to be prepared to give up what most would regard as well-earned leisure and to devote his time and energy to furthering the interests of the community. I am indebted to him for the following information with regard to the Association:— "By the 17th March, 1927, the results of a canvass of 11,700 houses in the Borough showed that 2,881 persons were willing to join the proposed nursing association, and by their contributions to guarantee an annual income of £981. It was at once decided to proceed with the scheme and to engage three nurses to commence work on the 1st July. On the 1st October, 1927, the Highgate Nursing Association united with the new Association, and on the 1st January, 1928, the North London and Tottenham Nursing Associations altered to some extent their existing boundaries in order to facilitate administration within their respective areas The new Association now covers the whole of the Borough, with the addition of that part of Tottenham lying west of Green Lanes, and a small portion of St. Pancras at the top of Highgate Hill. 32 The Association, has made a successful beginning. A senior nurse was appointed on the 1st June, 1927, two district nurses on the 1st July, another on the 1st October, and an additional temporary nurse on the 12th February, 1928. Three hundred and fifty-four cases have been dealt with and 5,647 visits paid—18 per cent, of these free of charge to poor persons. Subscribing donors numbering 342 have contributed £267, and 2,666 members have paid £765. Grants, donations and gifts from Local Charities, Public Authorities, Churches and Societies amount to £168. In this figure is included a sum of £83 18s. 5d. handed over by the St. Mary's Nursing Association, which ceased its activities on the 31st May, 1927, after 35 years of useful service in the Borough. The financial position of the Association is thus secure up to the 1st July, 1928, when most of the subscriptions become renewable. The conditions of membership are briefly these:—The minimum payment for a subscriber, his wife and unmarried children living at home is 4s. when the income of the family does not exceed £200 per annum, 6s. when the income is between £200 and £350, and 10s. when the income exceeds £350 but is inadequate to provide private nursing attention. Two months' subscription must be paid before a member is entitled to benefit. A person cannot join as a member when actually in need of a nurse, but can obtain service on payment of not less than 1s. 6d. per visit. Annual donors of not less than 10s. 6d. are entitled to free service for their domestic staff, and in cases of emergency can call in one of the nurses for any member of the family at a fee of not less than 3s. 6d. a visit. R. H. Crookall, Hon. Secretary, Borough of Hornsey Nursing Association." DISEASES OF ANIMALS ACTS. The following is a summary of the work carried out by Mr. F. G. Buxton, M.R.C.V.S., the Veterinary Inspector, during the year:— Twenty-two licences were issued, viz.:—Sheep 11, beasts 7, and pigs 4. 33 Forty-five inspections were made under the Diseases of Animals Acts of animals brought into the Borough, viz.:— 170 sheep, 307 pigs and 16 beasts. A small outbreak of swine fever occurred in the last quarter of the year. The animals which died showed typical lesions on post-mortem examination, and the diagnosis was confirmed by an Inspector of the Ministry of Agriculture and Fisheries. I am indebted to Mr. Buxton for the prompt and efficient way in which he dealt with the whole matter. PUBLIC EDUCATION IN HEALTH. In October, 1927, the Town Councd began the monthly distribution of 2,000 copies of the journal, "Better Health," throughout the Borough. Copies are sent to the various schools, public and private, to all religious organisations, to the various maternity and child welfare centres, to all general practitioners and to all persons engaged in forms of social work. Many expressions of appreciation of the journal have been received, and there is no doubt that the small annual expenditure incurred is already amply justified. 34 LIST OF TABLES. TABLE A.—Vital Statistics, 1901-1927. TABLE B.—Causes of, and ages at, death in 1927, and Summary 1921-1927. TABLE C.—Infant Mortality in 1927. TABLE D.—Births, Deaths, Infant Deaths, and Deaths from certain diseases, 1901-1927. TABLE E.—Cases of Infectious Disease notified in 1927. TABLE F.—Cases of Infectious Disease notified 1901-1927. TABLE G.—Notifications of, and deaths from, Tuberculosis, 1927. TABLE H.—Work done at the Maternity and Child Welfare Centres and by Municipal Midwife, 1927. TABLE I.—List of Acts, By-laws and Regulations in force in the Borough. TABLE J.—Inspection of Factories, etc., 1927. TABLE K.—Statistics as to Housing conditions, 1927. 35 TABLE A. BOROUGH OF HORNSEY VITAL STATISTICS, 1901-1927. Year. Estimated Mid-Year Population. Birth Rate per 1,000 Population. Death Rate per 1,000 Population. Infant Mortality per 1.000 Births. 1901 73,549 20.5 8.3 84 1902 74,653 20.8 8.6 82 1903 75,757 20.6 8.0 83 1904 76,861 21.6 8.9 86 1905 77,945 20.0 8.7 67 1906 79,069 20.1 9.8 84 1907 80,173 19.0 9.5 76 1908 81,264 18.2 9.2 63 1909 82,378 18.3 9.5 57 1910 83,401 16.7 8.8 69 1911 84,592 17.5 9.6 78 1912 84,840 16.3 9.9 75 1913 85,122 16.7 9.7 56 1914 85,456 17.8 9.2 57 1915 85,800 16.5 12.2 80 1916 86,147 16.0 11.5 46 1917 86,450 11.3 10.9 70 1918 86,942 11.7 13.8 61 1919 87,100 13.6 11.4 64 1920 87,410 19.3 10.3 54 1921 87,691 16.7 11.0 49 1922 88,007 15.4 11.2 54 1923 88,326 14.4 10.6 51 1924 88,661 13.4 10.4 41 1925 89,064 13.6 10.6 43.6 J 926 89,850 13.4 10.3 47.2 1927 90,000 13.3 11.2 38.3 107 County Borough and Great Towns, including London (Rates in 1927) 17.1 12.2 71 157 Smaller Towns (Rates in 1927) 16.4 11.3 68 London (Rates in 1927) 16.7 11.9 59 ENGLAND and WALES (Rates in 1927) 16.7 12.3 69 36 CAUSES OF DEATH 1927 All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and over. Registrar.General's returns. 1927 1926 1925 1924 1923 1922 1921 1 Enteric Fever ... ... ... ... 1 ... ... ... 1 1 ... ... 1 ... ... 1 2 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 Measles ... ... ... ... ... ... ... ... ... 8 1 2 4 3 1 3 4 Scarlet Fever ... ... ... ... ... ... 1 ... 1 ... 1 1 3 3 4 5 Whooping Cough ... ... ... ... ... ... ... ... ... 3 8 2 1 7 2 5 6 Diphtheria ... 1 2 3 ... ... ... 6 1 1 2 6 6 13 6 7 Influenza 2 ... 1 2 1 3 12 33 54 17 20 22 14 47 24 7 8 Encephalitis Lethargica ... ... ... ... ... ... 1 ... 1 2 3 2 1 ... 3 8 9 Meningococcal Meningitis ... 1 ... ... ... 1 2 ... 4 ... ... ... ... ... ... 9 10 Tuberculosis of Respiratory System ... ... 1 ... 11 31 14 1 58 59 48 65 47 60 74 10 11 Other Tuberculous Diseases 2 ... ... 1 1 1 1 6 8 7 7 11 18 12 11 12 Cancer, Malignant Disease ... ... ... ... ... 6 51 74 131 147 143 146 136 143 136 12 13 Rheumatic Fever ... ... ... ... ... ... 1 1 2 2 3 3 2 4 5 13 14 Diabetes ... ... ... 1 ... ... 2 5 8 7 13 9 10 14 8 14 15 Cerebral Hæmorrhage, etc ... ... ...... ... ... ... 10 36 46 60 68 53 60 54 68 15 16 Heart Disease ... ... ... ... 4 9 29 155 197 160 163 141 126 116 122 16 17 Arterio-sclerosis ... ... ... ... ... ... 7 31 38 41 60 46 44 44 40 17 18 Bronchitis ... ... ... ... ... ... 6 58 64 47 61 71 55 65 72 18 19 Pneumonia fall forms') 2 4 2 3 1 11 21 25 69 55 64 67 68 67 46 19 20 Other Respiratory Diseases ... ... ... ... ... 4 9 11 24 10 16 16 9 20 23 20 21 Ulcer of Stomach or Duodenum ... ... ... ... ... ... 8 5 13 9 7 6 8 8 4 21 22 Diarrhoea (under 2 years) 3 1 ... ... ... ... ... ... 4 2 3 1 5 3 15 22 23 Appendicitis ... ... ... 4 3 3 2 2 14 6 6 9 7 11 7 23 24 Cirrhosis of Liver ... ... ... ... ... ... 6 3 9 4 6 4 6 6 11 24 25 Acute and Chronic Nephritis ... ... ... ... ... 3 9 15 27 31 25 35 32 36 24 25 26 Puerperal Sepsis ... ... ... ... 1 ... ... 1 2 ... 1 1 2 ... 26 27 Other accidents and diseases of Pregnancy and Parturition ... ... ... ... ... 2 ... ... 2 2 3 2 5 3 4 27 28 Congenital Debility and Malformation, Premature Birth 35 1 ... ... ... ... ... ... 36 31 26 29 38 36 34 28 29 Suicide ... ... ... ... 1 1 3 ... 5 3 4 10 12 12 11 29 30 Other Deaths from Violence ... ... 3 1 1 4 8 6 23 36 27 20 22 22 21 30 31 Other Defined Diseases 2 ... 2 3 2 12 61 87 168 171 170 175 196 190 185 31 32 Causes Ill-defined or Unknown ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... 32 Total 46 8 11 18 26 92 263 549 1012 926 956 938 928 995 968 37 TABLE C.—INFANT MORTALITY, 1927. CAUSES OF DEATH. Deaths from stated causes at various Ages under One Year of Age. Total Deaths under One Year. Under 1 Week. 1-9 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Whooping Cough — — — 0 — — — — 0 Tuberculous Meningitis — — — — 0 — 1 1 — 2 Other Tuberculous Diseases — — — — 0 — — — 0 Convulsions 1 — — — 1 — — — — 1 Bronchitis — — — — 0 — — — — 0 Pneumonia — — 1 — 1 1 — — 1 3 Diarrhœa — — — — 0 — 1 1 — 2 Rickets — — — — 0 — — — — 0 Injury at Birth 3 — — — 3 — — — — 3 Premature Birth 15 2 — 4 21 — — — — 21 Atrophy, Debility and Marasmus 3 — — — 3 — 2 1 1 7 Other Causes 4 — — — 4 — 2 1 — 7 Total 26 2 1 4 33 1 6 4 2 46 38 TABLE D. BIRTHS, DEATHS, INFANT DEATHS, AND DEATHS FROM CERTAIN DISEASES, 1901-1927. YEAR. Population Census. Total Births Total Deaths Total Infant Deaths (under one year) Deaths from Measles Deaths from Whooping Cough Deaths from Diarhœa (under two years) Deaths from Scarlet Fever Deaths from Diphtheria Deaths from Typhoid Fever. Deaths from Cancer. Deaths from Tuberculosis (Pulmonary) Deaths from Tuberculosis (Non-Pulmonary) 1901 72 056 1,511 597 127 8 14 6 1 8 3 47 45 18 1902 1,565 620 129 7 9 1 0 9 6 51 45 22 1903 1.561 589 130 15 19 1 1 8 1 62 46 20 1904 1.659 690 143 18 17 21 1 7 2 49 54 23 1905 1,567 696 106 9 10 6 3 8 2 65 58 16 1906 1,603 769 136 18 4 22 6 13 5 65 47 13 1907 1,524 766 116 5 19 3 4 9 4 76 50 19 1908 1,485 752 95 12 11 3 3 9 2 84 53 16 1909 1,508 787 87 12 12 0 3 10 0 75 57 26 1910 1,393 737 97 1 10 0 4 8 3 88 41 18 1911 84,592 1.479 812 116 20 15 35 1 6 1 103 55 23 1912 1,385 840 105 5 2 13 3 2 2 114 43 17 1913 1,425 824 81 12 8 12 0 4 3 96 55 14 1914 1,529 791 88 1 4 21 1 7 1 82 44 10 1915 1,394 1,007 112 37 7 23 3 11 2 99 58 19 1916 1,404 928 64 0 5 8 0 11 1 106 84 20 1917 1.038 906 73 14 6 3 0 6 0 113 58 25 1918 1,037 1,094 64 6 13 7 2 8 0 130 76 13 1919 1,188 992 76 0 0 6 2 3 1 119 66 11 1920 1 707 657 93 4 7 7 S 20 2 119 61 12 1921 87,659 1.468 968 72 1 2 15 3 13 0 136 74 12 1922 1 372 992 72 3 7 3 3 6 0 143 60 13 1923 1,277 928 64 4 1 5 1 6 1 136 47 11 1924 1,189 928 48 2 2 1 1 2 0 146 55 7 1925 1,214 946 49 1 8 3 0 1 0 143 48 7 1926 1,206 928 57 8 3 2 0 1 1 147 59 8 1927 1,201 1,012 46 0 0 4 1 6 1 131 58 6 39 TABLE E.—INFECTIOUS DISEASES NOTIFIED, 1927. DISEASE WARDS. AGES Total Admitted to Joint Hospital. Admitted to other Hospitals. Registered Deaths Highgate Muswell Hill. Crouch End West Hornsey East Hornsey North Haringey South Haringey Stroud Green Finsbury Hark. 0— 1 1— 5 5— 15 15— 25 25— 4 5 45— 65 65 and over Scarlet Fever 29 25 16 13 29 27 13 15 12 0 41 95 29 13 1 0 179 131 6 1 Diphtheria 11 17 4 7 11 14 16 7 5 1 20 56 10 5 0 0 92 81 5 6 Enteric Fever 2 2 0 0 0 1 0 1 0 0 0 3 3 0 0 0 6 4 0 1 Erysipelas 9 6 1 5 5 6 4 1 1 1 0 1 4 8 13 7 34 4 3 0 Ophth. Neon 3 0 0 1 0 1 0 0 0 5 0 0 0 o 0 0 5 0 0 0 Pneumonia 7 16 7 24 12 11 4 7 1 2 17 10 11 18 20 11 89 3 9 69 Pueiperal Fever 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 Puerperal Pyrexia 4 2 0 2 2 1 0 1 2 0 0 0 4 10 0 0 14 0 1 0 Poliomyelitis 0 0 1 1 1 0 0 0 0 0 1 1 1 0 0 0 3 1 0 0 Cerebro spinal Meningitis 0 0 0 1 1 0 0 0 0 0 0 I 0 1 0 0 2 2 0 4 Paratyphoid 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 0 0 Malaria 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 Tuberculosis Phthisis 14 15 5 12 10 11 7 3 9 0 1 3 21 39 21 1 86 — — 58 Other Forms 3 1 2 0 3 4 3 1 5 0 4 2 5 6 3 2 22 — — 6 Total 78 85 36 66 75 76 47 36 36 9 84 172 89 102 58 21 535 226 24 146 Admitted to Hospitals (except T.B.) 40 35 12 25 39 34 29 20 16 - - - - - - - - - - - Note —The following non-notifiable infectious diseases were also admitted to the Isolation Hospital:—Five cases found not to be diphtheria, 1 return case of scarlet fever, 1 scarlet fever (notification withdrawn), 1 poliomyelitis (notification withdrawn), 1 enteric fever found to be chest trouble, 1 whooping cough, 1 whooping cough and pneumonia, 5 measles, 1 German measles, 2 chicken-pox, 1 mumps, 2 conjunctivitis, 3 skin diseases, 1 case for observation after operation; total cases removal to Hospital. 252. 40 TABLE F—NOTIFICATIONS OF INFECTIOUS DISEASE, 1901-1927. Year. Population. Scarlet Fever. Diphtheria or Croup. Enteric Fever. Para Typhoid. Puerperal Fever. Puerperal Pyrexia. Erysipelas. Cerebral Spinal Meningitis. Polio-Myelitis. Ophthalmia Neonatorum. Malaria. Dysentery. Encephalitis Lethargica. Pneumonia. Small-pox. Measles. German Measles. Total. Attack rate per 1,000 population. 1901 73,549 501 134 35 — 5 — 40 — — — — — 10 — 725 9.8 1902 74,653 261 99 38 — — — 33 — — — — — 35 466 6.2 1903 75,757 203 62 15 — 2 — 25 — — 2 309 4.1 1904 76,861 197 101 16 — 5 — 40 — — — — — — — — — — 359 4.6 1905 77,945 261 153 20 3 — 39 — — 1 — 477 6.1 1906 79,069 411 157 25 — 1 — 37 — _ — — 631 7.9 1907 80,173 283 98 11 — 5 — 34 1 — — — — 432 5.3 1908 81,254 239 93 9 — 3 _ 39 — — — — — — — — — — 383 4.7 1909 82,378 221 151 4 — 1 — 37 — — — — — — — — — — 414 5.0 1910 83,401 173 105 10 — 1 — 30 — — — — — — — — — — 319 3.8 1911 84,592 179 133 6 — 2 — 40 — — — — — — — 1 — — 361 4.2 1912 84,840 138 88 9 — 3 — 39 1 1 — — — — — — — — 279 3.2 1913 85,122 206 115 10 — 2 — 26 — — — — — — — — 359 4.2 1914 85,456 346 101 9 — 1 24 — — 11 __ 492 5.7 1915 85,800 182 105 18 — 5 35 9 3 1 — — — — — — — 358 4.1 1916 86,147 103 77 8 — 1 32 2 6 9 — — — — — 207 281 726 2.7* 1917 86,450 132 66 4 — 1 28 4 — 1 — — — 1,227 881 2,344 2.7* 1918 86,942 89 67 8 — 2 23 1 3 2 — — — 796 119 1,110 2.3* 1919 87,100 203 87 6 — 4 — 42 4 1 5 21 2 5 112 — 224 285 1,001 5.7* not now notifiable 1920 87,410 245 149 6 — 2 — 27 1 3 8 10 2 4 98 555 6.3 1921 87,691 591 189 2 — 2 36 — 2 6 1 1 6 42 — — 878 10.1 1922 88,007 286 123 1 — 2 24 — — 10 1 1 104 — — 552 6.2 1923 88,325 126 133 1 — — 24 2 6 4 2 75 373 4.2 1924 88,661 215 40 3 — 1 26 — 1 1 11 61 359 4.0 1925 89,064 126 53 10 — 1 26 2 2 4 1 1 7 60 293 3.3 1926 89,850 140 116 4 — 4 6 22 — 2 8 6 56 364 4.0 1927 90,000 179 92 6 1 1 14 34 2 3 5 1 — — 89 — — — 427 4.7 *Excluding measles and German measles. 41 TABLE G.—NOTIFICATIONS OF, AND DEATHS FROM, TUBERCULOSIS, 1927. Deaths Non-Pulmonary F . - - - - - - - 1 2 - 1 - 1 - - - - — 2 M 1 - 1 1 1 - - - — 4 - — 2 1 — 1 — — — 4 Pulmonary P i - 6 11 6 3 1 — 28 3 4 — 7 5 1 2 2 4 28 M - - - 5 6 8 6 4 1 30 5 2 6 2 7 1 1 3 4 30 New Cases. Non-Pulmonary F - 3 1 2 4 - - - 2 12 3 1 - - 2 - 2 - 4 12 M - 1 1 3 1 1 2 1 - 10 - - 2 - 1 4 1 1 1 10 Pulmonary F - 1 2 17 12 8 5 3 - 48 8 8 3 6 4 8 5 1 5 48 M - — 1 4 7 12 6 7 1 38 6 7 2 6 6 3 2 2 4 38 AGE PERIODS. 0-1 1-5 5-15 15 -25 25 - 35 35 -45 45 - 55 55 - 65 65 and over Totals Wards :— Highgate Muswell Hill Crouch End West Hornsey East Hornsey North Haringey South Haringey Stroud Green Finsbury Park Totals 42 - TABLE H. MATERNITY AND CHILD WELFARE WORK, 1927. Nature of Work. Centres. Totals. No. 1. No. 2. No. 3. Number of individual Mothers seen by Doctor:— Ante natal, New cases 167 71 47 285 ,, Old cases 353 168 75 596 Post natal, New cases 48 39 11 98 ,, Old cases 51 34 25 110 Total attendances of Mothers 906 385 164 1,455 Number of babies attending Centres for first time 385 259 145 789 Number of individual babies on Centre registers 900 517 347 1,764 Attendance of babies at medical consultations 3,956 2,507 1,283 7,746 Total attendances of babies at Centres 6,297 4,106 2,486 12,889 Referred to own private doctors 39 47 8 94 Referred to hospitals 85 44 14 143 Health talks given by nurses 4 24 30 58 First visits Total visits First visits Total visits First visits Total visits Total First visits Grand Total visits Visits paid by nurses : — To expectant mothers 68 11l 57 138 23 25 148 275 To infants under one year 508 2,572 295 1,532 311 924 1,114 5,028 To children aged 1-5 years 26 2,773 36 1,577 26 680 88 5,030 Total visits paid by nurses 602 5,456 388 3,248 360 1,629 1,350 10,333 RECORD OF WORK OF MUNICIPAL MIDWIFE, 1927. Confinements attended 122 Ante-natal Clinics attended 64 do. visits 284 Post-natal visits 1,609 43 - TABLE 1. LIST OF ACTS, BY-LAWS & REGULATIONS RELATING TO PUBLIC HEALTH IN FORCE IN THE BOROUGH, WITH DATE OF ADOPTION. Adoptive Acts.— Infectious Disease (Prevention) Act, 1890 (9th December, 1890). Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5 (9th December, 1890). Museums and Gymnasiums Act, 1891, so far as it relates to Museums only (1st May, 1893). Public Baths and Wash-houses Acts, 1846, 1847, 1878 and 1882 (6th July, 1896). Housing of the Working Classes Act, 1890, Part III. (20th July, 1896). Public Health Acts Amendment Act, 1907, sections 15 to 17, 19 to 27, 30, 31 and 33 in Part II., Parts III., IV., V. and VI., and section 95 in Part X.—by Order of Local Government Board, and section 81 (modified) in Part VII., sections 87 and 90 in Part VIII. and Part IX.— by Order of the Secretary of State (Home Office). The Local Government and Other Officers' Superannuation Act, 1922 (14th November, 1923). Public Health Act, 1925, Part II., relating to Streets and Buildings, Part III., containing Sanitary Provisions, Part IV., relating to Verminous Premises, etc., and Part V., relating to Watercourses and Streams, etc. (from 1st February, 1926). BY-LAWS, REGULATIONS, ETC., RELATING TO PUBLIC HEALTH IN FORCE IN HORNSEY. By-laws have been made as follows : — Cleansing of Earth-closets (22nd November, 1879). Common Lodging-houses (22nd November, 1879). Slaughter-houses (22nd November, 1879). — 44 — Management of Mortuary (6th December, 1886.) Decent Conduct of Persons using Sanitary Conveniences (21st May, 1894). Houses Let in Lodgings or occupied by members of more than one family (21st September, 1896). For Good Rule and Government of the Borough, 1909, 1913 and 1922. Nuisances in the Borough (10th June, 1907). With respect to New Streets and Buildings in the Borough (11th May, 1908, and 17th December, 1923). Also, Regulations have been made as to— Management of Sanitary Conveniences (21st May, 1894). Dairies, Cowsheds and Milkshops (19th June, 1899). Hornsey Swine Fever Regulations, 1904 (14th May, 1904). Regulations under Swine Fever Order of 1894 as to Movement of Swine (14th March, 1904, and 1st March, 1905). Regulations under the Dogs Order, 1906. Regulations as to Cleansing, &c., under Order as to Parasitic Mange in Horses, &c. Regulations under section 17 (7) of the Housing, Town Planning, &c., Act, 1909 (20th July, 1914). Offensive Trades (12th June, 1911). - 45 TABLE J._FACTORIES, WORKSHOPS AND WORKPLACES. The following is a summary of the result of inspections made at Factories, Workshops and Workplaces during the year, with a list of Outworkers' premises, a copy of which has been forwarded to the Home Office, as required. None of the Outworkers premises was found to be in an unwholesome condition. Premises. Number of Inspections. Written Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 316 9 0 Workshops (Including Workshop Laundries) 521 17 0 Workplaces (Other than Outworkers'premises) 54 2 0 Total 891 28 0 DEFECTS FOUND IN FACTORIES, WORKSHOPS & WORKPLACES Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts : — * Want of cleanliness 16 16 - - Want of ventilation — - — — Overcrowding — — — — Want of Drainage of floors — — — — Other nuisances 12 12 — — Sanitary accommodation insufficient — — - unsuitable or defective not separate for sexes — - - — Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouse (s. 101) - - - - Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). - - - - Total 28 28 — — •Including those pecified in sections' 2, 3. 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 46 TABLE J. (contd.) OUTWORKERS. Nature of Work. Outworkers. Instances. Notices served. Prosecutions. (1) Wearing Apparel :— Making, etc. 104 0 0 0 Lace, lace curtains and nets 1 0 0 0 Fur lining 1 0 0 0 Furriers 4 0 0 0 Fancy goods 4 0 0 0 Artificial flowers 4 0 0 0 Trimmings 2 0 0 0 Toys 1 0 0 0 Picture frames 1 0 0 0 Military and Naval badges 1 0 0 0 Painting tea cosy panels 1 0 0 0 Lamp shades 1 0 0 0 Embroidery 1 0 0 0 Venetian blind maker 1 0 0 0 Total 127 0 0 0 - 47 TABLE K. HOUSING CONDITIONS. STATISTICS YEAR ENDED 31st DECEMBER, 1927. 1.GENERAL. (1) Estimated population 90,000 (2) General death-rate 11:2 (3) Death rate from tuberculosis (per 10,000 population) 7.0 (4) Infantile mortality 38.3 (5) Number of dwelling-houses of all classes 20,262 (6) Number of working-class dwelling-houses (viz., up to £30 r.v.) 10,960 (7) Number of new working-class houses erected during year 110 2.—UNFIT DWELLING-HOUSES. I.—Inspection. Houses inspected 953 House-to-house 372 Infectious disease 324 (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,325 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 372 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 456 11.—Remedy of Defects without Service of formal Notice. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 705 II.—Action under Statutory Powers. (a) Proceedings under section 28 of the Housing, Town Planning, etc., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling-houses which were rendered fit— (a) by Owners 0 (b) by Local Authority in default of Owners 0 48 - TABLE K. (contd.) (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by Owners of intention to close 0 (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 123 (2) Number of dwelling-houses in which defects were remedied— (a) by Owners 89 (b) by Local Authority in default of Owners 0 (c) Proceedings under sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders 0 (2) Number of dwelling-houses in respect of which Closing Orders were made 0 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 0 (4) Number of dwelling-houses in respect of which Demolition Orders were made 3 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 3.—Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I., to (b) Part II., of the Act of 1890:— (1) Name of area (2) Acreage (3) Number of working-class houses in area (4) Number of working-class persons to be displaced IV.—Number of houses not complying with the building bye-laws erected with consent of Local Authority under section 25 of the Housing, Town Planning, etc.. Act, 1919 0 V.—Staff engaged on housing work with, briefly, the duties of each Officer Borough of Sornsen. ANNUAL REPORT FOR 1927 of the School Medical Officer. INDEX. Anæsthetics, Number of. 7. Nervous diseases, 15. Attendances at Welfare Centres Clinics, Non-tuberculous cases, 15. 8. Nose and throat defects, 15. 19. Aural clinic, 5. Nurse, additional, 8. Aurist, Report of, 6. Nurses' visits to Schools and homes. 8. "Better Health'' journal, 12. Ogilvie Home, 8 Blind children. 11, 17. Open-air education, 8. Boots and clothing, provision of. 10. Open-air School 8 8 Breathing exercises instructions, 4. Ophthalmic Clinic. 4. 5. Camps, 8. Organised games. 9. Care Committees' work. 10. Orthopaedic treatment, 7. List of cases helped. 11. Ottorhœa, Cases of, 6. Chicken-pox, 7. Paralysis, 7. Children treated at Welfare Centres. 3. Parents. Attendance at medical inspec- tions and clinic. 7.10. Parkstone Home of Recovery, 8. Physical training, 9 Children treated at Clinic. 4. Physically defective children, 18. Playground classes, 9. Coldfall School, 3, 8. Playing fields. 9. Convalescent homes, 8, 10. Politzerisation, 0. Conveyance of school children, 8. Preface. 2. Co-ordination with Maternity Centres Proceedings for verminous conditions, and Secondary Schools 8. 4. 21. Crippled children, 7, 8, 18. Deaf children, 5. 11. 17. Records. Transfer of. 3. Defects found. Return of. 15, 16. Refraction. 5. 20. Defects treated, 19, 20, Remedial exercises. 7. Deformities, 15. Residential Schools, Children sent to. Dental clinic for children of pre school 7, 8, 17. age. 8. Ringworm, 5, 19. Dental defects and treatment. 3, 4, 6. Routine inspection, 14, 15, 23. 15. 21. Russell-Cotes Home. Parkstone, 8. Dental sessions, 7. Dentists. 1. St. Mary's School, Alterations, 3. Educaltion Committee and staff. 1. School Camps and journeys 8. Epileptic children. 11. 17. School list and accommodation, 22. Eye diseases. 4. 5, 15, 19, 20. School Medical Officers clinic, 10. children under 5 years, 5. School Nurse, additional, 8. Following up of cases. 8. School Nurses' visits and inspections, 8. Friel. Dr. A. F.. Report of, 6. Seaside holidays, 8. Hearing. 5. 11. 19 Secondary schools. Medical inspections, 8. Heart disease. 15 Skin diseases, 4, 5. 15, 19. Hvgiene. teaching and booklets. 10, 12. Speech, defective, 15 . ,. . Special Schools, 11, 17. 18. Impetigo, 4. 5 19. Spectacles, provision of. 5, 11, 20. Infantile paralysis, 7. Infections disease in schools. 7. Sports competitions. 9. Sports grounds, 9. Legal Proceedings. 4. 21. Sports. Report of secretary, 9. Lung defects. 15. Squint. 5, 20. Maternity Centre School Clinics, 8, 4. Staff, 1. Medical inspections at Clinic, 4. Stammerers' class. 11. ,, ,, at School, 3, 23. Swimming, 9. Medical Staff, 1. „ Bath additions, 9. Mentally defective School and children, 11. 17. rabies, 13. Mentally defective children notified to Tonsils and adenoids, 4, 21. Central Authority. 17. Treatment required numbers. Mentally defective children, 11, 17. Tuberculosis, 5, 7, 8, 15, 18. Mid-day meal arrangements at schools, 3. Uncleanliness, 4, 21. Milk provided. 11. Minor ailments, medical officers, 1. Verminous conditions. 4. 21. Minor ailments treated, 19. Vision, Defective, 4. 5. 19. Minor ailments, treatment at Welfare .. Spectacles. 5, 11, 20. Centres, 8, 4. Whooping-cough, 7. Mumps, 7. Myopic children. 11. X-ray treatment, 5. Hornsey Education Committee. 1927. The Mayor, Alderman. W. G. Barrenger, J.P. (Chairman). Alderman W. W. Kelland, M.A. (Vice-Chairman). Alderman H. B. Brackenbury, Councillor A. J. Marriott, ,, F. E. Grayson, ,, E. W. Mayatt, ,, B. H. Jenkinson, ,, J. W. Rowlands, Councillor A. A. Bell, ,, J. W. Shipp, ,, Mrs. C. M. Cave, ,, R. H. L. Watson, ,, C. Knight, ,, R. Ff. Wootton, Selected Members. Rev. H. C. Montgomery- Mr. H. Tompkins, Campbell, M.C., M.A., Mrs. A. Holman, J.P., Rev. Clifford Wood, Miss I. J. Jameson, M.A., Mr. T. P. McNaught, Mrs. J. Whitehead. Secretary: A. W. Allen, M.A. MEDICAL SERVICES STAFF. School Medical Officer ... W. W. Jameson, M.A., M.D., M.R.C.P., D.P.H. School Oculist and School Medical Inspector J. 11. Prior, M.D., LL.B., D.P.H. Aurist A. R. Friel, M.A., M.D., F.R.C.S. (I.). Radiologist J. Morison, M.D. Medical Officers attending Minor Ailments Clinic J. T. D. Clark, M.B., Ch.B. G. F. Rigden, M.C., M.B. Dentists W. P. Beresford, L.D.S. C. H. Rubra, L.D.S. S. T. Taylor, L.D.S. Nurses M. Anscombe. L. M. Oliver. F. E. Paris. Clerk H. M. Croak. Assistant Clerk V. Powell. PREFACE. To the Chairman anil Members of the Education Committee of the Hornsey Town Council. Ladies and Gentlemen, I have the honour to present to you the report for 1927 on the health of the elementary school children in the Borough of Hornsey. The large amount of work that is done year by year among the school children could not be accomplished without the willing co-operation of all concerned. In this respect my thanks are again due to Mr. Allen, to Dr. Prior and to Mr. Hatcher. I have the honour to be, Your obedient servant, WILSON JAMESON. — 3 — GENERAL. Co-operation between the various health services in an area is essential if a real measure of success is to be attained. During the year under review special efforts were made to improve existing working arrangements and to link up as closely as possible the Maternity and Child Welfare Service with the School Medical Service. Thus nearly 400 school children made some 3,550 attendances at the three " Welfare Centres " and received treatment for minor ailments either from the health visitors or from, the school nurses. Considerable numbers of children under five years of age attended the school clinic for the treatment of defective teeth, squint and discharging ears, and it is probable that in the near future the school dental clinic will be made available, after school hours, for the dental treatment of mothers and of children of pre-school age. A satisfactory system exists for the transfer of information from the Maternity and Child Welfare Service to the School Medical Service in the Public Elementary Schools and again from the latter to the Secondary School Medical Service. Arrangements for the medical inspection of secondary school pupils is, of course, under the control of the Middlesex County Council, but, by a process of delegation to the Local Higher Education Committee, the County Council have helped materially to co-ordinate local health services. Certain very necessary alterations have been carried out at St. Mary's Schools—a new sanitary block has been provided for the infants' department; the boys' school has been re-modelled and a new classroom added. The new school on the Coldfall site, to accommodate 840 scholars, has been commenced, and should be completed before the end of this year. It is hoped that a day open-air school will also be erected on this site. Arrangements similar to those in force during the past five years still exist, both for the conveyance to and from school of certain children and for the provision of suitable accommodation at various schools where children have to remain on the school premises during the mid-day interval. MEDICAL INSPECTION AND TREATMENT. Thirty per cent. of the children on the rolls of the various schools were inspected on a routine basis during 1927, while 2,249 special inspections were also made. The latter figure 4 shows a considerable increase on that for 1926. These special inspections were conducted both by the medical practitioners, who have attended the school clinic on two afternoons a week, and by the School Medical Officer, who holds a weekly morning session. Of all children submitted to routine inspection 9.8 per cent. were found to require treatment of one sort or another. Large numbers of children came to the Central Clinic for treatment and advice—thus 1,666 attended the dental clinic, 1,105 the minor ailments clinic and 758 the ophthalmic clinic. The total number of attendances amounted to some 10,000. (a) Uncleanliness.—There has been a definite decline in the number of verminous school children detected at the various inspections. At routine medical inspection the percentage of children so affected was 2.7, as compared with 4 2 in 1926. The school nurses, who made some 33,000 examinations of children during the year, foundi 549 children unclean, whereas in 1926 the number was 755. There has been a continuous rise in the standard of cleanliness in all schools for some years past, and there is no reason why the efforts of the school nurses, to whom with the head teachers all credit for this improvement is due, should not result in the attainment of a still higher standard in the future. Fewer children were dealt with at the Cleansing Station —123 as compared with 221 in 1926—and in only 10 instances (42 in 1926) were the powers given in section 87 of the Education Act, 1921, exercised. In no case was it necessary to take legal proceedings against parents. Personal cleanliness is the foundation of personal hygiene and a child who has been taught to be clean has been given a fair start on the road to self-respect. (b) Minor ailments.—These ailments, which consist mainly of impetigo and other skin conditions, cuts, bruises and such like, are treated daily at the Central Clinic, and at the three Maternity and Child Welfare Centres. Over 5,000 attendances were made by children suffering from such conditions. (c) Tonsils and adenoids.,—One or other or both of these conditions existed in 10 9 per cent. of the children inspected. One hundred and thirty-eight children (nearly 2 per cent. of those on the rolls) received operative treatment at the Clinic, while 56 were similarly dealt with elsewhere. The parents of those children who attend the Clinic are given printed 5 - tions as to the importance of suitable breathing exercises after removal of tonsils and adenoids, and arrangements are made for the district nurses and the school nurses to visit the cases for some days after the operation. (d) Tuberculosis.—As in previous years all children show ing suspicious signs of pulmonary tuberculosis were reported to the Tuberculosis Officer. In 1927 the number so reported was '29. Arrangements exist whereby delicate children, especially those coming from houses where cases of tuberculosis are known to live, may be sent for varying periods to open-air residential schools (see page 8). (e) Skin disease.—Apart from impetigo, the only skin diseases of any significance discovered during the year were ringworm of the body (5 cases), ringworm of the scalp (4 cases) and scabies (2 cases). Both the cases of scabies received treatment at the Cleansing Station and all the cases of ringworm of the scalp were submitted to X-ray treatment. (f) External eye disease and defects of vision.—The principal external eye diseases dealt with were squint (41 cases), blepharitis—an inflammatory condition of the eye lids—(27 cases), and conjunctivitis (13 cases). An endeavour has been made to secure the attendance at the ophthalmic clinic of all children under five years of age found at the Maternity and Child Welfare Centres to be suffering from squint This condition can be treated satisfactorily only if the sufferers receive adequate export supervision at an early age. One hundred and ten children, or 5 per cent., of those submitted to routine inspection, were found to have defective vision. The school oculist, who attends twice weekly at the Central Clinic, examined 758 children and discovered a total of 465 defects, of which 374 were errors of refraction. Glasses were prescribed in 309 cases, and by the end of the year had been obtained in 217 cases, or 88 per cent. Sixty-four children received treatment otherwise than under the Local Education Authority's scheme. (g) Ear disease and hearing.—Fourteen cases of deafness were referred for treatment and 2 for observation. Only 29 cases of ear discharge were found to require treatment, as compared with 74 in 1926. This decline in the number of children suffering from ear discharge appears to be due entirely to the careful treatment given to such children by Dr. Friel at the weekly aural clinic, 6 - Dr. Friel reports as follows regarding all cases attending his clinic during the year: — " The statistics of otorrhœa for the year 1927 are of children attending the elementary schools and of children of pre-school age sent from the Infant Welfare Centres in Hornsey. It is desirable that the latter should be treated at the earliest opportunity in order to avoid, as is usually possible, the development of chronic otorrhoea. The treatment adopted is of the same nature as has been followed since the clinic was started. In addition to the children suffering from otorrhoea a good many have attended complaining of deafness. These are usually treated with Politzerisation. If the cases are in an early stage the results are good. Cases of otorrhœa. Cause of Suppuration. Total ears. Cured. Lost sight of. Still under treatment Needing hospital treatment Acute suppurative otitis media 29 28 1 Chronic suppurative otitis media due to— Tympanic sepsis 17 16 1 Tympanic sepsis + granulations 2 2 Tympanic sepsis-)-polypus 4 1 3 Tympanic conditions + rhinitis 1 1 + attic disease 2 1 1 + mastoid disease 12 3 4 5 External otitis 11 10 1 Cause undetermined 1 1 79 100% 59 74.6% 8 10% 7 8.8% 5 6.8% A. E. Friel, Aurist." (h) Dental defects.—Dental inspection as carried out at school mcdical inspections is of little value, as slight degrees of 7 dental decay can be detected only with the aid of a dental mirror and a probe. Thus, whereas at medical inspections only some 21 per cent. of the children appeared to suffer from dental defects, the school dentists referred for treatment 63 per cent. of all children examined by them. A special effort was made during 1927 to examine and treat children at the age of five years. The parents of the entrants are invited to attend dental inspections in order that the dentists may explain to them how necessary it is that temporary teeth should receive adequate treatment. During 1927 eight dental sessions were held weekly—20 half days being devoted to inspection and 316 to treatment. The school dentists examined 3,741 children and referred 2,708 for treatment. Of those so referred 1,666, or 62 per cent., actually received treatment. A general anæsthetic was administered on 1,293 occasions. The school dental service is popular in Hornsey and, as additional sessions are being arranged for 1928, there is no doubt that in the near future every child attending the Hornsey elementary schools will be given the chance of having adequate dental treatment before reaching the age for leaving school. (i) Crippling defects.—There are 35 crippled children on the books of the elementary schools in the Borough. In 16 of these cases crippling is the result of infantile paralysis and in 6 of tuberculosis. During the year 3 children were sent to residential institutions for cripples and 1 to a day cripple school. Advantage is taken of the facilities offered by the orthopaedic hospitals and departments in the Metropolitan area, and no difficulty is experienced in obtaining hospital treatment for crippled children, provided the parents can be induced to bestir themselves in the matter. There is, however, a definite need for the provision of remedial exercises, and it is hoped that, if the proposals for the establishment of an open-air school materialise, this form of treatment may be included in the scheme. INFECTIOUS DISEASE. The schools have been free from Serious outbreaks of infectious disease during the year under review. Chicken-pox, mumps and whooping cough affected certain departments, but never reached epidemic proportions in the Borough. Measles was almost entirely absent. 8 FOLLOWING UP. There are two school nurses whose duty it is to visit the schools and to cull upon the parents whose children have been recommended some form of medical treatment. Without the advice and intelligent assistance of these nurses school medical inspection and treatment would lose much of their practical value. In 1927 the nurses paid 1,164 visits to various school departments and 1,583 visits to the homes of the scholars. Much additional work has been thrown upon the nurses by the completion of the housing estate at Coppett's Road, and a great deal of one nurse's time is spent in travelling between this estate and the Clinic. When the new Public Elementary School, now in course of erection on the Coldfall site, is completed an additional nurse will be required, whose duty it will be to act as school nurse for the new school as well as for the contemplated open-air school. It is anticipated that rooms suitable for a minor ailment clinic will be available at this new school, so that the nurse will be able to carry out a great deal of useful work within a comparatively restricted area, and children will not have to make the long journey to Crouch End when only simple forms of treatment are required. OPEN-AIR EDUCATION. The usual playground classes were held last year, but the inclement weather experienced naturally caused a good deal of interruption. Two school camps were again held, and 80 children from Campsbourne School and 26 from St. Michael's and Highgate Schools attended. Two school journeys were undertaken; 20 girls from North Harringay School spent ten days in France and 40 from Stroud Green School visited Broadstairs for one week. Ninety-two children were sent for a fortnight or longer to holiday homes at Herne Bay and Bognor. The eight places reserved in the School of Recovery at Parkstone and the Ogilvie Home at Clacton have been utilised to the fullest extent, 36 children having been sent during the year to one or other institution for a minimum period of six weeks. The erection of a day open-air school for delicate and crippled children has been approved in principle by the Town Council, and it is hoped that before long such a school will actually be opened 9 on the Coldfall site. At the moment of writing inquiries are being made regarding the type of building most suitable for the purpose and visits are being paid by members of the Education Committee to various open-air schools in London and the provinces. PHYSICAL TRAINING. A full programme of physical training and of organized games has been carried through as in previous years. Organized games and school sports are held on fields at Redston Road, Rokesly Avenue, Newlands Eoad, Priory Road, Highgate Woods and Finsbury Park. Before long another playing field will be available on the Coldfall site. In addition, large numbers of games are played in the school playgrounds—out of the usual school hours —in the form of systematic inter-house and inter-class competitions. Instruction in swimming has been given in the school bath during the summer months, and 1,040 children made at least 50 per cent. of the possible attendances at the school bath during the swimming season. At the beginning of the session 260 were able to swim, and by the end of the session another 417 had been taught to swim. A footbath with a shower has been installed at the school swimming bath. Mr. Gilbert, of North Harringay School, General Secretary of the Hornsey Schools' Sports Association, has been good enough to give the following short report on the work of the Association : — The Association continues to organise competitions between departments in tennis, net ball, football and cricket, and between schools in athletics and swimming. The number of competitions has been increased considerably of late years, in order to afford opportunities of play to as many children as possible. The organisation is now complete in respect of fourteen such competitions, whilst further opportunities are provided by a series of games in which teams representing Hornsey as a whole oppose teams from other districts. The Association appreciates to the full the ready and generous help which it receives from the Borough Council, the Education — 10 — Committee and the Council's officials. Many requests have been made during the past year for assistance in ways which are calculated to increase the efficiency of the efforts made by the Association for the welfare of the Hornsey scholars, and many more will doubtless be made. These requests have ranged over such diverse subjects as the provision of a shower bath at the swimming bath, the increasing of the facilities and conveniences at existing grounds, and the provision of trophies, and they are being met with the utmost consideration. The Association remains convinced that any efforts which can be made for the furtherance of organised sport among the scholars of Hornsey are productive of excellent results, not only as regards the physical welfare of the children, but also as regards their training in habits of sportsmanship and good fellowship." CO-OPERATION WITH PARENTS AND OTHERS. Arrangements have been made for the distribution to parents of small booklets giving useful information, not only on educational matters, but also on questions relating to health. Certain information from the Board of Education's table of exclusion periods in infectious disease has also been included. Parents continue to be present at medical inspections in fairly good numbers, 76 per cent. of those invited having attended during 1927. The teaching staffs and attendance officers work in close harmony with the school medical service. At the weekly clinic held by the School Medical Officer the Chief Attendance Officer is always present and all cases likely to present difficulty in one way or another are there dealt with. The Care Committees have again done most excellent work. Assistance has been given to parents in the purchase of surgical appliances, clothing and boots and the provision of convalescent home treatment. Members of the committees visit the homes of children who are about to leave the special school for mentally defective children and keep in touch with these children after they leave school. It is hoped to extend this work in the near future to all children leaving any of the special schools to which Hornsey children are sent. The following table shows the number of cases which have been provided with milk, cod liver oil and spectacles through the agency of the Care Committees: — 11 District. Number of Children provided with Milk. Cod Liver Oil and Malt. Spectacles and Repairs. Sundry. Campsbourne 87 71 21 41 Crouch End 54 172 20 29 Highgate 38 19 9 5 North Harringay 3 24 12 4 Total 182 286 64 79 Parents are required to contribute, as far as possible, towards the cost of the articles provided, but in 67 cases of extreme poverty the cost was borne cither by the Care Committee or by the Education Authority. In the majority of cases the parents succeed in their efforts to repay by weekly instalments the whole of the outlay incurred. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. The numbers of such children vary very little from year to year. During 1927 there were 15 children attending the special classes for the partially blind in Wood Green, 7 the special school for deaf children in Tottenham, 29 the joint special school for mentally defective children, and one a special school for epileptics. The School Medical Officer examined 28 children reported to him as certifying officer under the Mental Deficiency Act, and of these 11 were admitted to the joint special school. Four of the scholars left this school during the year and all are now in remunerative employment. Five children Were notified to the County Council as requiring supervision, Reference to table III. (page 17) will show how all the various types of defective children in Hornsey are being dealt with. STAMMERERS. There are two classes for stammerers, a senior and junior, and each meets twice weekly under the care of Miss Bains. Twenty-four children have attended during the year, and of these 9 were admitted for the first time and 3 were discharged. 12 These children as a rule make excellent progress while attending the special classes. Under the skilled supervision of Miss Bains they lose much of their self-consciousness and regain a great deal of self-control. The greatest difficulty is experienced in getting them to practise in school and elsewhere what they are taught in the special classes, and too many of the parents take but little interest in the routine to be followed by a child who is to rid himself of this distressing defect. Without the co-operation of parents really satisfactory results cannot be obtained. During 1927 the School Medical Officer examined 14 young persons from 15 to 19 years of age who had attended the special classes for varying periods and on leaving school had obtained remunerative employment. The following is the summary of the result of the examination:— Original degree of stammering. Number. Present Condition. Slight 3 All cured. Considerable 8 Cured 1. Much improved 3. Improved 4. Severe 3 Improved 2. No change 1. TEACHING OF HYGIENE. In his "Report on the Health of the School Child for the year 1920" Sir George Newman devoted a considerable amount of space to the subject of health teaching in schools, and made a strong appeal to Local Education Authorities for the inclusion of such teaching in the curriculum of all their schools. In Hornsey the systematic teaching of hygiene has been practised in the schools since 1904, when a syllabus of simple lessons on personal hygiene was issued to all head teachers. This syllabus has recently been re-issued after revision by representative persons interested in the subject. During the past few months some 1,200 copies of the journal, "Better Health," have been distributed monthly among the various schools, public and private, in Hornsey, and it is hoped that the accurate information on health questions contained in the journal will have a wide-spread influence for good in the Borough. 13 LIST OF TABLES. TABLE I.—Number of children inspected. ,, II. (a).—Defects found on examination. ,, II. (b).—Number of individual children found to require treatment. „ III.—Return of exceptional children in area. ,, IV.—Return of defects treated. Group I.—Minor ailments (excluding uncleanliness). Group II.—Defective vision and squint (excluring minor eye defects). Group ///.—Treatment of defects of nose and throat. Group IV.—Dental defects. Group V.—Uncleanliness and verminous conditions. ,, V.—List of schools, accommodation and number on rolls. ,, VI.—Return of children inspected at each school. — 14 - TABLE I.— RETURN OP MEDICAL INSPECTIONS, 1927. (a) Routine Medical Inspections. Number of Code Group inspections— Entrants 845 Intermediates 555 Leavers 667 Total 2,067 Number of other routine inspections 117 (b) Other Inspections. Number of special inspections 2,249 Number of re-inspections 2,752 Total 5,001 15 TABLE II. (A)-RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1927. Defect or Disease. Routine Inspections Special Inspections No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Malnutrition — 201 — — Uncleanliness 84 — — — (See Table IV, Group V). Skin Ringworm, scalp — — 4 — ,, body — — 5 — Scabies — — 2 — Impetigo - 1 — 63 Other Diseases (Non-tuberculous) — 6 55 — Eye Blepharitis 9 2 16 — Conjunctivitis — — 13 — Keratitis — — 4 — Corneal Opacities — — — — Defective Vision (excluding Squint) 110 — 105 — Squint 7 — 34 — Other Conditions 11 — 75 — Bar Defective Hearing 12 3 2 — Otitis Media 7 1 22 — Other Ear Diseases — 2 35 — Nose and Throat Enlarged Tonsils only 28 186 50 — Adenoids only — 6 17 — Enlarged Tonsils and Adenoids 7 7 115 — Other Conditions — 4 57 — Enlarged Cervical Glands (Non-tuberculous) 11 152 39 — Defective Speech 2 10 — — Teeth—Dental Diseases 453 — 13 — (See Table IV., Group IV.) Heart and Circulation Heart Disease: Organic — 3 — — Functional — 61 1 1 Anæmia — 12 103 — Lungs Bronchitis 1 57 34 — Other Non-tuberculous Diseases — 3 — — Tuberculosis Pulmonary: Definite — — — — Suspected — 4 4 — Non-Pulmonary: Glands — 1 — — Spine — — — — Hip — — — — Other Bones and Joints — — — — Skin — — — — Other forms — — — — Nervous System Epilepsy — 1 — — Chorea — — 7 — Other conditions — 4 5 — Deformities Rickets — — — — Spinal Curvature 2 1 — — Other Forms 2 4 — — Other Defects and Disease 16 51 352 — 16 TABLE II.—(contd.). (B)—NUMBER OF INDIVIDUAL CHILDREN FOUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UNCLEANLINESS AND DENTAL DISEASES). Group Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (1) (2) (3) (4) Code Groups:— Entrants 845 49 5.8 Intermediates 555 75 13.5 Leavers 667 68 10.2 Total (cade groups) 2,067 192 9.2 Other routine inspections 117 14 12.0 17 TABLE III.—RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Boys Girls Total Blind (including partially blind). (i) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind — — — Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — (ii) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind 8 8 16 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Deaf (including deaf and dumb and partially deaf). (i) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 3 4 7 Attending Public Elementary Schools — — — At other Institutions 1 — 1 At no School or Institution (ii) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf — — — Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Mentally Defective. Feebleminded (cases not notifiable to the Local Control Authority.) Attending Certified Schools for Mentally Defective Children 12 17 29 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Notified to the Local Control Authority during the year. Feeble-minded 1 — 1 Imbeciles 3 1 4 Idiots — — — Epileptics Suffering from severe epilepsy. Attending Certified Special Schools for Epileptics 1 — 1 In Institutions other than Certified Special Schools — — — Attending Public Elementary Schools — — — At no School or Institution — — — Suffering from epilepsy which is not severe Attending Public ElementarySchools 4 1 5 At no School or Institution — 1 1 18 TABLE III.—(contd.). Boys Girls. Total Physically Defective Infectious pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At other Institutions — — — At no School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At Certified Residential Open Air Schools — — — At Certified Day Open-air Schools — — — At Public Elementary Schools — — — At other Institutions — — — At no School or lnstitution — — — Delicate children (e g , pre-or latent tuberculosis, malnutrition, debility, anaemia, etc ) At Certified Residential Open-Mr Schools 18 18 36 At Certified Day Open-air Schools At Public Elementary Schools 50 61 111 At other Institutions — — At no School or Institution — — — Active nonpulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board — — — At Public Elementary Schools — — — At other Institutions — — — At no School or lnstitution — — — Crippled children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those with s e v e r e heart disease. At Certified Hospital Schools — — — At Certified Residential Cripple Schools — 3 3 At Certified Day Cripple Schools 1 — 1 At Public Elementary Schools 20 15 35 At other Institutions — — — At no School or Institution 6 1 7 19 TABLE IV. (A)—RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1927. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). DISEASE OR DEFECT. Number of defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm, Scalp 4 — 4 Ringworm, Body 7 — 7 Scabies 2 — 2 Impetigo 223 — 223 Other Skin Diseases 70 1 71 Minor Eye Defects (External and other, but excluding cases falling in Group II). 60 — 60 Minor Ear Defects 57 — 57 Miscellaneous (e.g., minor injuries, bruises sores, chilblains, etc.) 489 — 489 Total 912 1 913 20 TABLE IV.—(contd.). Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. Number of defects dealt with. Under the Authority's scheme. Submitted to refraction by private practitioner or at hospital,apart from the Authority's scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report). 374 60 — 434 Other Defects or Diseases of the eyes (excluding those recorded in Group 1). 91 4 — 95 Total 465 64 — 529 Total number of children for whom spectacles were prescribed (a) Under the Authority's scheme 309 (b) Otherwise—0. Total Number of children who obtained or received spectacles (а) Under the Authority's scheme 271 (b) Otherwise—0. Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Total number treated (5) Received Operative treatment. Under the Authority's scheme, in clinic or hospital. (1) By private practitioner or hospital, apart from the Authority's scheme. (2) Total. (3) Received other forms of treatment. (4) 138 56 194 57 251 21 TABLE IV.—(contd.). Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist:— Aged Routine Ago Groups 5 400 6 375 7 420 8 180 9 157 10 346 11 183 12 408 13 170 14 95 15 49 Total 2,783 Specials 958 Grand Total 3,741 (b) Found to require treatment 2,708 (c) Actually treated 1,666 (d) Re-treated during the year as the result of periodical examination 341 (2) Half-days devoted to Inspection 20 Treatment 316 Total 336 (3) Attendances made by Children for treatment 4,782 (4) Fillings Permanent teeth 978 Temporary teeth 799 Total 1,777 (5) Extractions Permanent teeth 580 Temporary teeth 4,158 Total 4,738 (6) Administration of general anaesthetics for extractions 1,293 (7) Other operations Permanent teeth 532 Temporary teeth 116 Total 648 Group V.—Uncleanliness and Verminous conditions. (i) Average number of visits per school made (luring the year by the School Nurses—48. (ii) Total number of examinations of children in the schools by School Nurses—32,975. (iii) Number of individual children found unclean—549. (iv) Number of children cleansed under arrangements made by the Local cation Authority—123. (v) Number of cases in which legal proceedings were taken— (a) Under Education Act, 1921—Nil. (b) Under School Attendance By-laws—Nil. 22 TABLE V. LIST OF SCHOOLS IN THE BOROUGH. School. Department. Authorized accommodation. Average No. on the Rolls for yr. ended 31/12/27. Muswell Hill Junr. Mixed 220 265.9 St. Michael's Senr. Mixed 238 133.4 „ Junr, Mixed 175 119.7 Highgate Senr. Mixed 444 311.3 „ Junr. Mixed 354 241.4 North Harringay Boys' 416 401.5 „ „ Girls' 416 379.3 „ „ Junr. Mixed 462 423 South Harringay Senr. Mixed 570 427 „ „ Junr. Mixed 300 263.3 Stroud Green Boys' 418 368.1 „ „ Girls' 418 332.5 „ „ Junr. Mixed 426 359.4 St. Mary's Boys' 237 236.2 „ Girls' 235 245 „ Infants' 220 216.6 Crouch End Boys' 456 347.5 „ „ Girls' 450 302.6 „ „ Junr. Mixed 411 366.8 Holy Innocents' Infants' 101 109.8 St. James' Mixed & Inf. 269 318.9 Campsbourne Boys' 450 362 „ „ Girls' 450 353.5 „ „ Infants' 473 444.5 Totals 8,609 7,329.2 23 TABLE VI.—ROUTINE MEDICAL INSPECTION, 1927 Number of children inspected at each school. YEARS OF AGE. 5 6 7 8 9 10 11 12 13 14 15 TOTALS. School. B. G. B. G. B. G. B. G B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. Total Muswell Hill 23 24 12 13 4 2 17 7 1 — — — — — — — — — — — — — 57 46 103 St. Michael's 9 11 3 3 — 1 5 9 — 1 3 — — 2 14 9 2 4 — — — — 36 40 76 High gate 14 14 6 12 2 6 19 16 4 1 1 — 2 — 26 22 5 1 — — — — 79 72 151 North Harringay 57 31 24 21 5 5 26 33 4 3 6 3 5 7 60 54 9 8 23 21 — — 219 186 405 South Harringay 31 21 20 14 6 5 12 14 3 2 5 5 1 2 22 23 3 1 7 12 — — 110 99 209 Stroud Green 36 25 10 15 14 10 31 21 6 4 5 4 4 2 42 37 6 1 21 12 — 3 175 134 309 St. Mary's 34 26 12 11 6 2 23 26 4 4 1 — 3 4 15 20 3 3 — — — — 101 96 197 Crouch End 35 32 13 14 — 5 11 3 4 7 4 5 2 5 64 53 14 10 11 — — — 158 134 292 Holy Innocents' 14 14 4 8 1 — 1 1 — — — — — — — — — — — — — — 20 23 48 St. James' 9 8 8 6 — 4 12 12 4 2 2 — — — 8 13 1 1 — — — — 44 46 90 Campsbourne 54 46 30 18 5 4 3 7 4 11 — 6 — 1 53 44 7 9 1 5 — 1 157 152 309 Total 316 252 142 135 43 44 160 149 34 35 27 23 17 23 304 275 50 38 63 50 — 4 1,156 1,028 2,184 845 555 667 117